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�.� 7 A_QL-i COLTv' V+'�ZO?���+:A� :_'I i= DIVISION <br /> STI= __A A.LI A�+t� S,A E'i`r ?LA-N, - <br /> ?A-R:7 <br /> ?sem: I PARR:'` <br /> SAL Si: %!7r0P.W-ON :--V. AMON OF Pa-PvuAL "r_ay-RDS <br /> PaM� <br /> _. Site Na*� '�' <br /> e: � i <br /> Address: I F 1101 V,10r U o.J <br /> Cone=?_-sat: Perms, RrLt4 ?home No. 22 [1 Ca-r-a_rves: <br /> Sweevs - u=e: �I <br /> ?-noosed Date of r*ver�so.^_/sveorr 2 ('� p'2- ,ios�ves: <br /> Z Deseipcor: and brief=--a-•re ofe^_:oa a6-"*vity. C IIy Erorpm—ic Gases: <br /> ( 1 New US '--s=Qzr:o= C I UAR %-ves-..gatiaa Kme <br /> I -'ark Cos-=e - ?act [ j 7ark/10--pe -RA== ( j C::�ize-s <br /> ( ; - :V°ipe Re-movai ( j � 72. on <br /> ( 1 %rt a=om of 3or-_;,/Moriror_mg Weirs <br /> L�? g P(L ?A-R7- <br /> Sce- c Site <br /> No. -a=� C_pactr. HQUE-01 <br /> Lr CaD.te_^_ts: -L a=k 7 <br /> =ase_ or ai. one^.::ors <br /> -;fie ='e=appmp «am:zdorv,e or7.s-moors are <br /> [ -)rovide-_) <br /> �. R_{':se ( I ..ar..nu-pie Gas/0--n Mer_ <br /> lidera-c_ or leaks/sou II--*^"'�*^ot:: [ - �=5 (i VO i i ]e*__�- -des �Sce^.=71 <br /> �oc���-ed G�Ldwzt= cott*---•�-�to�- o-atcior'=-oz De=' r <br /> 3ac,g-ot=d id des----p=a= or' .:.y ?re�ioLs •ve_�ga-cn (: Cry= Vapor:rz:�.� <br /> or =cde"Mce.• ( I Ctre_; spe-%y: <br /> L= are .i <br /> =ror='e or <br /> S. ?oce^_.tal He t= and Sai_^! <br /> Coec_=: (C=ze, _it ^..:..ar-Cpiy 3c dese_"De) <br /> -e_t or -aid Sys: OF (= ar�ie�*tem_) <br /> p,d Noise Sot== ?-. Ce-=e <br /> �i C--7.-e-- De_^_ce=cT <br /> Terve! of (IA [ Ic [ IC M-D <br /> har <br /> anaZing and ora ::azrdovs Sti:s.3ac:: �Q Safe_-y z=es/;olz-Q-;es <br /> (Lrr, e�las:ars, eS�) Slee coed/sh—- simes or JooC$ <br /> ( I Cotaed Soac_ (e=iosiorts) [ i : ecave-n-Ills <br /> (pays.: ! =P=7 3c a:es imz.; <br /> =roti =oQ*s; e�utpz`ert) ( I 777ek <br /> ( j 3esoL-amr, cc e. A <br /> • vg or SC3A <br /> sci <br /> Sarery vesC <br /> 7. - cpare= 3ioio =z rrs ( I Two-:gray cow Wi�oe <br /> [ i Saa:Kes ?oisaaot`s N—ts <br /> ( j <br /> 0d+e_/Urico�vr- Cspe=ry1: ?a"c- :V <br /> PLAN APPROVAL <br /> *-7erovide a%? %far_-don waic caLd sac-e3!` <br /> .? 2 ( q OZ <br /> °_^.d Safeey, e.g., :owe= ii-es, imre r7 or d5ces, =-.31-, ems): ?rte, ?renZTM: by- L.Ia,Z <br /> 7tS S�Dr77ed7Y. Da''' ��y <br />