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hazardous Waste T.ek Closure Certkheatlim <br />C Anyunand"en'ndPpagepionMmftimiilartypdcridd etmktg,d21,WASng,atrCtrmtlon Matmk nso,, Ihaementi moepadilions Belau: <br />-ISd cult 6,belm.1sed, nnaled bald rclowdsin mderielasIteatdam wane. aMnrvidenn/tad sea har/trdade wATte,nM tan[ <br />isdetlntdtn be diapaa:d. roslaimnl a choo6 irtPlacc <br />- <br />This does not &V* ro tank 37mml repiiaed under a htsdma naom laoiy Permil, other than <br />Imnin areq. trot to a lent system amy Pot rion easeoS dot sern the deanition Ora n22 CC suic(PB 10=di "Clo edfro R pstRub ortderagtsanol <br />CCR (i66261.6(a)(3J(Bj e'N nmtffi is 22 CCR 46636d. 10 atM in ueludetl from rcpuiatiw laarsa4pt to 22 <br />Refer to 22 CCR 467383.3 and Al CCA 42672 far disposal requirtmera Rwtw* syRe,,e <br />(Note do mmmberingoftbe ingnxtlont lbllora litedstaelaeva ttmtbastiop>.cet ole TRCF peaet 11te¢dsp olmamtnvnaan <br />sen wW for elacamie mtbrtdaslon mmol aro the same As Ow namberirg used in27 CCR Appendix C, the Business Seetioo of tM <br />Unified Rover Dor Dicsiolry.) <br />Pieac omme Eli pages olylor stomienl, Tins helps unlit CUPA a heal agtatry idmtrry witetlarthe submitW is eomldem r+r+d if vny Pagaa ere anpvatad <br />I. FACMT7Y TO NUMBER - Lease thisburk This number isadgrtedbylhe CUPA. Tmi%0wwipnemmfberwhichidmiifiea yoarfecilay. <br />3. BUSINESS NAME- Fnwdw hill lapd rune orthe bugm o, <br />740. TANK OWNER NAhM- <br />Complaaintra T40.7M, wltaail itoa se the supeafie Baines(Tyner <br />741, TAWK OWMER ADORE$$ <br />m4knil tlon(itoan 111-176)on theBelftSS QvpgiQperEmr ldentificatim page <br />742 TANK OWNER CTTY <br />(GES Foca 2M), If** arose -rive "SAW AS SITS ae,eas this axlfoa <br />743. TANK OWNER STATE <br />74C TAMC OWNER ZIP CODE <br />74S TANK TD NUMBS[ /4 - Ewer VPpdnee *"W1 Urdu 1D nmmbcm TMs is a shp, somber in" by fie omen M tdrnufy dto <br />lick <br />747st.)ihrt thrss mtka are being e7ao4 emnpltle sOdldotatl idPia oflida Pa®e (Suer addaioaW laM mmlfeT6ln <br />11 anod 751.) <br />746 CONCEN MATION OF FLAMLIUME VAPOR I-3 - Em since rntesior t1we 10 sePM leach for cath lank Ming closed, <br />, 1 ad she rP-te as and bom" of ow mak. (Formalsman oro Ynle. Ruta sddionail link rtadinp in 749 and 757.) <br />747. CONCPMRATION GF OXTOF-N 1.3-EftWth ee intens asyg a ie¢els for ado Wk being elm d, liken of the lop. center, <br />aM boson ofshc rrtk. (Fa saae,frn oro link carr eddiODaul beds mdinp in 750 and 753). <br />SIGNATURE- T7t btektess mvlmuaeffoerefthe compury Who is aalhnmod m make decisions for the focilit7 and who lata opnninnN cnmrol, shall sign in <br />dtc apace po7tdad <br />754. CERTIFIER NAME- Eamr Ore faU pritaed Most tdllt Peraem aigttMgtlm Pugs <br />755, CERTWMRTITLE-ETftrthetitieofdwpo Againgmepoge. <br />756. cmTnmm ADDRE55-Enterdranddt ormepmmsfgnirethepw <br />757. CERTIFMR CITY - Sides me City fadto sigdcr's sddmei <br />758. CERTIFTPR 7'HONE _ Fipartltr idteote number fa the pmoe apmaj tt Pep. <br />T79. DATE CERT7F7FD-Eimldrfiedtdr list medoexnemwdgosd, Einer Utp Nmetlmtfiercadirmp acre then. <br />760..CER7TFVM REPRESENTS LOCAL AGENCY -Mmic-Ya ifMeptnoo soEf7ingeMYnk isa2pre5ergo4ct of me GZ1PA, dsarred age+Kr,aLiA. <br />ehex: -Nel if nm ou <br />761. NAME OF LOCAL AGENCY - Fitwi the tune ofmc local ageaq mprerepsed by oto Arson Mfg" the tank <br />762. AFF7LIATON OF CERTIFYING PERSON -Cheek the ser0fiea6oq hem,, orugaiaadon svhkhthe c0lifier holds or to wMah <br />Ole ted lyjht omen he imp irmor a CUPAILTA. <br />763. TANK FIELD FLAT4dABLB OR COMBUSMLE MATERIAL$ -Chest `Yav ifthe tank held flatmabk oreanrcmible nnrsie6, ehcck'No ifnoi <br />764. U(ANAMMENT 1NSfRUCTON3- Pmn ids tank mingtmpa imtmetiam W the 34tap dtalce. diaposd feu lay. �. in ahfs spat, <br />(TPCF (17199) <br />40 <br />FwMCrlY DT3C 3249 (6/99) <br />