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UNDERGROUND STORAGE TANK CHECKLIST <br /> Plant # NO11�F <br /> Tank Size (gals: )Tank 10 # = - - _7. <br /> Date Removed or Closed <br /> Eng i neer Comp I et i ng Form <br /> Copy to T. W. Simon - SFO <br /> R . W . Fish - WCRC <br /> 1 <br /> 1 <br /> I . Local Authority <br /> Agency ' <br /> Contact Person Vjgg. lteP i^ Date Contacted O 9�gS <br /> Phone Number r " <br /> Tank Closure Permitted : In Place C 7 Removal <br /> Review Sign Off Form With -Local Authority <br /> ;r <br /> II . Contents of Tank <br /> Empty 'C 7 Contained Liquid <br /> Contents . &,!Zrrf."•l" <br /> Contents Hazardous/ Yes C 7 No <br /> t Amount Removed (Gallons ) - <br /> Transporter <br /> Ga1Ions ) eTransporter Name Fes, < _77, k, <br /> EPA ID Number : i,4D QQ ! /i 9 3 o/2 <br /> TSD Fac i I i ty : _Z7 7—C C 11(,�e A e-Sf <br /> Contact Person <br /> Phone Number <br /> How Treated an Disposed : "01P <br /> EPA <br /> t EPA iD Number : C4V 000acl<1 Z <br /> III . Tank Removal or Closure in Place <br /> A. Local Inspectors �///n tr� � f ��n �l LVrI <br /> Notified : /o '':= s <br /> Present Dur i n5' Remova I <br /> Inspector ' s Comments = <br /> Documentation : Tv. . 1+-•. '� , ".'c �' <br /> Al <br /> i <br />