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06%02/2005 10:11 FAX 510 614 8396 PARADISO 31ECHANICAL Z003 <br /> 05/31/2005 09:15 FAI 510 614 8391 pARADISO ,1IECHANICAL [Moog <br /> 9AR JOAQDW C4>tWPY <br /> KrMM0101MAL EMALTS DVARTINENT <br /> IIM=GROUND SWRA,GE TANK MM)SITION TRACIONG RECORD <br /> r##i*rsrtsalr#rrrrt*rrrsrtlrrrslts•titirirrttsrrtsrr!!!#trrrrstr■rrr!!**rrsssltlrriltarrrtrrr*lwlttrAfrrsrr <br /> 6F.G nON 1—RX Eaviuo==W Hcan Dm's Task TMcking&beet 565T9 accaqPMy ezeb tank aMxed with Is she <br /> ideaubmion number. The T®k Tieoldng Sheet is ro be returned m the 13nvkvn=Wd HNA&DW124 t.eit4i A dM of <br /> aeepUMM of$lo tmk by the disposal or m7'clinB faciHW. The p*rmlt huller is tuba fnr ensarpog dst 2»Than ie completed <br /> and rehanod- 11ff <br /> VAMnY NAtME: __ :.ta*terr�Gb e <br /> FACILITY ADDRES&_ 3 _� ✓" C I�n C l� <br /> TANK ID#39- t"�6L ' &TANK SUE:L��_ PREVIOUS TANK CG1�1T�11'S: PP�r� 60 <br /> str**+ls**0 rrrsstrl0000$ad***tss*rr <br /> SECTION 2-To be filed cm by task rtzavval ecubmehW. <br /> Tank Rwwvnl Co�aater P IED d M�L�D a c,d►L 1 H G <br /> Address'-9JotA2 1tJ l�cs1 e.mL T CILyi •]�1. I.b H DQI� T.� <br /> ?MMO ft(gyp`} i -QS O Date It&Xa wve&- <br /> *rrrs****rrts♦w*iitrrrt**yrrsrtrrssrsisrrrrrrtrsrrrr*ai•rstrrss•str#t!ltirsrrsst■tsrtrsrarsss�s■tlrsltrsrs• <br /> SECTWN 3-To be Mad out by custrrcbr"deanntaa iasd ng tisk": <br /> Tsak Icon Coao:actar �I ILLI(y15 ��—R V 1 ' �� �r•�C1 �� - <br /> Addt+ess: `7`c6 Ar <br /> AuUwriad repr4BenWve of eon"OW emufy"through LIgnatmv below that the task has been tammsmd in an approved <br /> manner w mquhcd by Cal EPA. <br /> Namo: YD ,�-_.. � rti�.s Titled krrJ ,� -- 5igoanu+e: Dees <br /> trtrrtrrrr**♦##Itrrr*rrl�*iirirrrrrrrrr*�#irr•rrrrrrrra***a44*10woorrtrri�•lwr+�rrrrr�ri**��rtrr■�rrrrrr■■rrr <br /> SECTION 4-To be signed and dated by an aatborUcd repmentatwe of to treahmea;sbviage,Or disposal f&ci>ay <br /> accepting tank=&o r pipiw <br /> Focft Name: YA-a�U 4Ab Fr 11_ �r��r Ks ULE L L-e <br /> nn JJ33 73 /Vf4PA _�r <br /> Address: 1 Clty:_ �o ntr4r 1� Zip: W <br /> Qate rack Rmoivd' 3 os- �r <br /> of,4 <br /> Janne: . AATV16 7th: <br /> a >/,4«f <br /> irrsrsls#rrrrasrr**lstrrr*t•+t*res***rrrrtlt«*�i#s#ri*rrrs lsairr#♦sw*res!»;*#+rssrssr*A**tsr#**s**"* <br /> H 23 046 (Revised 10116103) Page 10 <br />