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ua ui; 0U 1l1U 17:Ur rAA.& ; UV 460 1067 FORWARD INC. Q005 <br />RAH EWIR0NMENTA PAGE 03 <br />09/01/2000 ) 6:51 9165529 F. <br />- 0-20[tfl l�f�N <br />10;34 AM NLFt'SA4A1"1EN Ifl <br />JUL 1 <br />S,t+Y dp�.QLfL*t Coyj%, TY PUBLIC iHIALTR SERVICES <br />E,aS/LROMLE�TaL H ALTH DLYISION <br />Lr?YMEAGRflgTOFtAGE TANK DMOSITION-MACKL*+G RECORD <br />•#wa■•rMa••rnF'rMAr.r#.■0rraa.r..s■A*r#r+#Ora lira a■ 00■46■ a" <br />ra+►aaa.rr.+�■a1*■.rw..d4y.Vr•arwr■-wA •a.r ww■aw• <br />as <br />SECTION 1 - Publiz Health S c Tank Tracking Sheet s to Da cs ed 'v Public Health Sar ices En �iMrmental{Htalth � sionh <br />it SI[L lCatttilicttia 7 }i�itnbct <br />,,;[ dsys of accoptatlCe of th& tank by Ibe disposal w rcc7C:i1g ta:il:ty- The permit holder is rcepon+iblr fGf Gtia[L^g t s: <br />thh corm ij cairtpleted ;nd torurnal, <br />FAC:I-ITY NAME! NRUAaR <br />FACILITY ADDUSS: 44i t7cxz0 <br />TAST=XTQX, CA 91 Z23 <br />ANK iD #39 /TIANK SME P'kF-Y1 ,L'S TANK CON—TENTS; T <br />do (< n �w^41 r..Wr.v.w..rr4 rsrsMrssa.00000,�.r......r.r.rw.r:�rww«w+�+ <br />#rMMr0s0rrWa�+a�rrrW*rr■Ma�wrrrraraf�s-.t■rNrs■•w.+Mkr . <br />ACTION Y - To be Ii11acS out by tank resneeal conrractor <br />Twk 'Removal Centreeior: Mg 2WVTxG=X=AL <br />' Addrzis: 331 sGTilTZ _ _--+ City;—lana— ZLP: 9565{1' <br />Phone 1: ( L—) 4 2^S 55 Date Tw& Rrineved, --� <br />IOU ■rY0M*r.■rialwasa!Mfr`Frl1...*YMi�.JM.M-MF�ili.aa..Yrlar.1.f#'%iYNr+ara��79'rY/riirrri.w*�M�Y.r.r-r-..r.f <br />SECTION 3 w To be filled aut by cOntrwe"t "decontaminating. tank <br />'Tarsk atzonuminst,lor► Corarat;tor; <br />adds ass: 31 Glw: alp: <br />Phoae 0; ( 916 <br />' ALMorizad repreeellLadVe oFC0r1t2rfor certifying through 3ignigge b.lo- :hat the tank has boon deConi Minmed in ut APprnved <br />ntuwr as requimd by Cel EPA, <br />1 Nam <br />Tltie; Stature Date <br />frrallrif004666•■■ar/al�r��rrw�*■■■rW**r•r■.ar*�rrFF+*iflilraa.sMW+/Mr■a400lrM•+A#Lra.r■w••,�rra �laia•r.•l■irrr rra <br />Alt oral faCd[ty <br />SEMON a - To be sided and dated by, wfavth <br />cri:d "Irtmtatfvat the 174MMCM, vvrtgt,oc p <br />ace41tk tU1lt <br />/�d4K�!// <br />Fseley Ntitn=; <br />q 4, f y Aos 7", City Zip <br />� S' �� <br />Addrwis- ' " <br />Pliant q;�)of G e 1 f ea <br />Date Yank Enceived: Y It / 2006 <br />Name:, <br />Tltie: ���` dreg �61ir+atu = Hatt <br />r■0■irraaru...�arrinrii■r■■�w.ra.r r 0140V 6Aa.+*,p0T■• OPEN 000-0200006aas1prr•r■w,.•iYair.rr.ea.rr.+araOaw.Mrr�t. <br />St3 23 046 (xev{sed 08/13199) <br />1 <br />fate ID <br />