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" PACILI Tr WJZ: �- <br /> FACILrry ADW�RSS: �./ <br /> This foxy isto 110 �ctW�iD TA} Dx�.4ITiQIdACfCit� RRj �—f -�9 <br /> ried to San <br /> acce"" cue of tal*(a) by dia stn Loral Hoalth District <br /> with vtthtn 30 day, of <br /> rumor p0�° or rlirrg facili <br /> notes lla rna1 porrstblp f ty' The holder of the permit <br /> returned. or orrrtnq that thta <br /> form to Acted �utd <br /> R * r r * R r r ft <br /> t e a r * t r t r t <br /> To be filled out by <br /> tank <br /> r s r * R r e R a t R * R R R <br /> ink Reboval C r l contr r: SELMON 1 <br /> mean':_ SI N <br /> Dategesoved TWvj Rip <br /> �, of Tanks,�� <br /> 8RL^TUH2 - To befilZodout � r * tlfRr * * RtReRr * Rlrr <br /> '�cor:taalnatlonm Contr ar �� �tireTank t ls)4= <br /> Addr� Dl E ' <br /> Lb b ; Pharx �q ��fol7,� <br /> Authorized representative of ZiP 9Sa-Vp <br /> ha_i(have) been �tractor cer tl fi es <br /> decontasti ted in an by stgrrtng below that c(s) <br /> oI ' waved r as aIylif <br /> � J <br /> AND " C <br /> * rr �° <br /> treatment iTObef12led out RrrRrrR * * } * ' <br /> storage and siWj&�Ptlng <br /> y-an autho <br /> Facilitye I p 00�t�DV rtdsrepresantative of the <br /> Address CA 06742 )• <br /> i"•1�i <br /> t R t t t t t t ♦ t [ [ ♦ ♦ [ t \ 1 t . <br /> ',C).tLlls: tt �'.L'TIOlIS: Feld In hal= and staple Affix proper iWt• <br /> RPP. # 3 <br />