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C&j41;���_ <br /> SUSPEN`"�ON OF WORK-A'PPLIMON FOR11�I <br /> FOR OFFICIAL USE ONLY , , n <br /> U5TCF7 Date Received �! t 'q7 , a <br /> 3 <br /> PARfiA, <br /> . :STATE. CIARD. EIE1 <br /> L­ Does this site pose an imminent threat to human health,safety,or the'environment? Y ❑ N <br /> Explanation: { <br /> 2. Do your records support the applicant's certification that the Preliminary Site Assessment Items I through 3, as applicable, <br /> have been satisfactorily completed? Y N ❑ <br /> Explanation: <br /> 3. Do you recommend in favor of granting a Suspension of Work? Y N ❑ <br /> Explanation: <br /> Signature of SWRCS Representative: SLI:kvI?ate. /p !'"/ <br /> LZ <br /> - - -- --,_ <br /> :: .. PART, RECUT€�R'S ]C .� I <br /> I:- :"Does this site pose an imminent threat to human Health,safety,or the environment? - 'Y ❑ N <br /> --Explanation- <br /> 2. Do your records support the applicant's certification that the Preliminary Site Assessment Items 1 through 3, as applicable, <br /> have been satisfactorily completed? Y N ❑ <br /> Explanation: <br /> r 3. ~ Do you recommend in favor of granting a Suspension of Work? Y N M <br /> Explanation: <br /> Signature of Regulatory Agency Representative: Date: 3 <br /> Print Name and Title: i�i a ria c-e--tLcc r i D e ►1 t I <br /> r <br /> Page 2 of 2 SWRCB SWA Farm(Version 1/97) <br />