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uv, u1, V 1AL, 11 :VO res .ub 400 iuti7 FORWARD INC. @004 <br />' <br />RAH ENVIRONMENT PAGE 02 ®9N®1-/21303 ] 6:51 916%5269 P. <br />- 4-21][ia Iidi <br />10:33 AM FAX '40, 316 933 <br />�liL 1 <br />]OAQLLN Cot -STY PUBLIC Hg kLTH SERVIM <br />E y-Utp.-L%[E`t7Aj. HI.aLTH DIVISION <br />L"ERGRO[![`iD SWRArF, TAJYK L7[SpOSSTiOY TRACKEXG RECO" <br />�rir�aararMra�aw■artf/r■*rr�■FiwrrAFF*..rMW■rwi..�rry■rxNrtwr..iPr�rssrr■wti+• <br />r■rtrrt.rwa Vrsw•rrs■r■ti.w •w.w•t►rr. <br />SECTION 1 - [�tblia Heal ge ccs ELLvlranMdnt7�l Health Division Tusk T; ack(ng Sheet s1hall secvmputy rnch tHc3 th Dk d u°ut, <br />orl <br />Els strc ldentifiotstiotl nutttbar- The Tusk Ty t.c disposal ertrbe r -Yell g�cillt . The permit holder' is rupons blafur{cruuf A%ihi t <br />wSrt*' of acceptutee of the tank by P <br />this form is comPlated and retutaed- <br />FACILITY PI,• MF--- HSHARZ SLEEM PAP 01►AD C <br />FACILITY A[3DMS: <br />5 vc>k a <br />TAMC ID R39 - (� r <br />TANK 5[ZE:Sao c�z a,L g ppEVICUS TA-,rK CONTENTS' -a 6cnr ff <br />r� k -o3 &AA**was". 'Yw'Mw■■#■WM+iLi■.•i Lrl ay■aary.■yxrra4YaaL <br />•.r�aa*�+�WWwaMa•.►+Ir*ro■aYww■aw it+sm. ■•a.arMr■■wx•*r*■ <br />SECTION 1 • To be filled out: by tank retneee[ eoutraatos: <br />TAnk 1tAH <br />' A.ddmss: 3.310 5 Orr —1 r a , Zip; 956a <br />Phare P { 916 , e32-5993 Cate Tuck Removed: <br />' #r■rtrr*wowvr a•rMi <br />rrrrriirartrr�rra�t+rtrtlWrw r�rtri/Wart•rAar.siYRk+arr■asr■a.fiaryr■■ w■ w.r,rr a■.■r..r�r■ w nwsrr <br />SgC71ON 3 . To be tilled out by �nntraetae "deroatttutrtn■e[tsd teak": <br />-rank Pamntrttnlnst[on CotleTactor: — - <br />Address.,_ 33 T City: Zip: ogfign <br />' Photo <br />Aurborited rfFra mive of contractor certifying through sifnaturo tr Gw that the rartlt 'hes bcan dKontzm[namd In an approved <br />ml <br />tt iamr as r+equfre4 by Cal BPA, <br />Tleitr _ Signature t #Pare <br />rrt+� <br />■r�IMlrwr*rrMai+YM�Maa�*�#M�rrrrl4*�rw.ars*rirrr�r*Wa■mama■■■ mow* Rwi■r..r■*arr+Mrrras*rr■.faaaaaar�■rr <br />SEC130M 4 - To ft signed wW diced by art suthut'it4d eeproenta"V4 of the: treatrt:enr. smragts, at dispexal irt:tliry <br />Facility Kam r � _. City-._ zip; <br />Address;G1 <br />Phone 4: (,r ?5)� <br />' Due Tank Icceivrd: <br />t+faute' % <br />dU� Title�1�S f�J�Si;nater Date�� <br />• •yr■rar■xr■a+ sow wig 40lLWwr.rtT■w W■rrra■■trio Mwrrra*.rtwrtart"gra■■■ari*r�.rw•a.iaaa a■rt�..r■r■ <br />•■r.aWrrrartrr.r.�. <br />EH Z7 044 (Revised MOM) ?ME 10 <br />