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06/i6/99 WED 08 a6 FAX 510 ,633 .0.759 7:7, P- 2 1 <br /> r GmHi�dsorsg 209 . 241 1 <br /> ...01 : 24p :='" <br /> " PICEIVED <br /> JUL 0 7 1999 <br /> S&N JO^Qr,IN COUNTY l uc TS SERVICES <br /> ENVIRONNl t ;L HEALTH <br /> L1NJ)�cGt4L1NDST4Rw68TAlYKDLSart TlRaCxc�r� CtaERMIT / SERVICES <br /> ............ ........ .......... .......ar.«• <br /> 5EC710N 1 -Public He2k6 scrvim Eavi:nra:cuW Health Divisico T=k caching Slicer shad aoaompany rack tank.afft cd With <br /> its sicc 4dencfit aoori cumber. The Tolk Traddag Sbect i5 robe mnuned to Gc ir <br /> Heakh Services Fnvonmarat Mc-nick DivLOOa ... <br /> ` *irlLn 3a dan of acrcpt3aec Of'd=rade by the*Wal or aecyclio;Faeili The pamil.bel4cz tis eeepoaa�le'lar eacusifl8 char <br /> ous rorty is complexed sad Mtw=d, <br /> FACILRY NAME.' A / r d i- fC/� <br /> FACfi=ADDR-55; /� �3 �� '�h o r T''C� !{ <br /> TANK TA x39 a 9- TANK 512£: PR.EVIO S TANK CONI- SENT - 15:0.1.r o i. <br /> ...r..ra...-....r-..r...r....ae..w..rr..r.rrr.wr.+►+.�.+r.r..w s...rr...rrr.ww+wra.....•e►rrr..rvr.�►..r••r <br /> SECTION 2-To be-fWcd our by tank rPmava!ceauamo '. <br /> Tank Removal Cracmr: �t�i 'T f J �� f rr a 7` a'7 <br /> AddrerS: 1�a a ��d�os. 4J a . C-ty/Uew� drzip: q.."z <br /> phone x: Z(„4>q� z• y�- -Z 5r O Date Tank Ramnw.d: <br /> ......r............-...a......r...rv-R.................... .....sa+.+a..wwra...ra...w <br /> SEC'1'TON J-To be filled ou&t,y cvm-mlor"d6/a'o/tamJo�txAg rsJl�d[•" <br /> Taal[ Deronmmuwiaa Cvrstrattor: ��I�3'� v �-- <br /> nddress: o ,� � C iry:J�,�,�Wwzip: 9V45W <br /> Authorized mpreseawive of coattartor J:•ertifying through sigAanuz bc[Qw the taIIk bas bccn decou-minated iQ ao;tpPTo-ed <br /> mamer as requixcd by Cal EPA. <br /> ,•lama �t-W.tGZ.� Title: ,e✓ / � r m: flaaz <br /> ..---------------------- .......J.........ai .ar...rw...•..rw_ <br /> SEC-nON a To be,xi V d and davedd-by as amtor4cd rxpre Utanive of the aca—ca stocitp,or dispneal fatuity <br /> acc(:pdng tank an&or piping" <br /> Facility N=lr: �' / L' �I /r,J� <br /> Address:. <br /> Mac T3uk1tzceived- /�,�/ /*Y 77) - <br /> ���: -- <br /> ........_ _.w..........r...................___...�--.ww.�_ ..--. . <br /> F14 23 046 (R,,Diced 1[1/19/98) Yagc 1[� <br />