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I'NIF'1 ED PROGRANI CONSOLIDATED FORAI <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> r,c r eT I <br /> - — 1. FACILITY IDENTIFICATION <br /> BC516 F.SS <br /> NAME,sm+srnCIL4Tf Aaa¢.ro6A-odr;asana A+; ' t FACILIII'ID5 I <br /> TANK OWNER NAME <br /> TANK OWNER ADDRESS c�� <br /> (..p12t_.�C�in Slre2�r i_MAeca� CIA ZIPCODE u <br /> TANK OWNER CITY <br /> 71. TANK CLOSURE INFORMATION ' <br /> TwMD9 I Cmabtmdm ofPlammab{e vapor Coxrcruaoan ofOaygm <br /> �uxh.YW:auinrx <br /> Top cel. scour) T'op Cerner <br /> TBmlom <br /> ANK OM�a iW ice- ]J]a H]a 74hmTF. Hai + <br /> ATMOSPKERE 1 � �,YA 1JA iJT Nb Jl4k <br /> ou <br /> RukD4VCE .+ NY <br /> 15 <br /> R <br /> M. CERTIFICATION <br /> Oncmvircsion oCllu Mnkllxrih'rFA,ank is vprx(If Cue fmm product slvdg;Nals S4hin,OakT rcid,ato(gr&tanaclxJ.rira2au vnd darts lfunhu ttJrin 4hx ' <br /> 4hei antradmprocidM hcnm ismx am attunmb Nr best of my krwwlMSe. <br /> SIG A RE OFCERTIF ERSTATUSORAFFIWTIANDFCERTIFYiNGPERSOV <br /> G <br /> L'enifertvarepras-n:amwo:,,heCUPA amhor,]NagemT.or LIA. <br /> FCERTIFIER n4 ❑ Yes <br /> [ <br /> y nr <br /> . a Name oCCUPn,auJro]izcdamtts;'.aLIA. <br /> a! <br /> TCi LE OF CERT{FIER <br /> " _ {(unfi¢ns otlur 4M1en C17PA'iiA chet#appiomia4<hoz heioW. H� <br /> KESS l7 ❑ a. CerteiedtMstriai H7giemulCiH) I - <br /> c L — t l r` Q I, Crim Sale*P:o4ssioral ICSP} <br /> ! � c.Cmified Manu Chem:R(CMC) <br /> I " <br /> 1] d. R[giverW Fivirmmemal Hcmtlh Spe[uli>:4RF.HSi <br /> U e. Pro`eAionat Enginm:fPLl <br /> PROVE / Q <br /> j^ (� —(p U ❑ r Cluj 11 RegiyNrwl Em irmmen:m Alulvr - <br /> _ g Cerj.tI s'Sime Licwce Dowd:,cn d[,.x101(1111h 1.01M. ! <br /> DATE ]~ CERTIF'CA:ION TIME s'Jhuan[e«ab+m:Crni+.'rcaaoa7 <br /> Y11 it <br /> tI TAN PREYIOLISLYHCLDFLAMA:ABLEORCOMBUSTIBLEMATERIALS <br /> arca ivw.i eenrrrniA�abYhnt!rbl:.xna[acbut+iCkY+<:S�s:fwW:•n.+nt DWi a<sma a¢W�::i.) YL! <br /> rCERTIFIER'S TANKMANAGEMBit INSTRUCTIONS FOR SCRAPOF_4LEP DISPOSAL FACILITY,ETC: <br /> I <br /> ��A myyaitNsa+uf.,�xgW1»airym:ih=:ak watcreryde}i dgowilxiM.m:li<zcvie;l+o=he CJPA.1!aarhxti�P.i copieedNl E:aup:u�wtlwSe L:A xdauhorixd � _ <br /> �Eev.a,.n+e va�w,Ma:e+vat svnv�x+ewalwaasJc u:l:lx:mcGn�_Lbsywi ail:rc- ..___-..--_.. <br /> Foirmerly DTSC 1249(6199) <br />