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Dat �Q�1 � X987 <br /> PERMANENT CLOSURE/TANK REMOVAL PLAN: ENVIkUiviENTAL NzALTH <br /> FERMIT/SERVICES <br /> Facility Name : �� 'Lp ,��'� S �ioh (OOZO <br /> Facility Address : (!A 9533 <br /> Owner Name : �rn ped-ya(p,��vc �ypcf��r' ('�Uyyrnahc� <br /> Owner Address: ;.O(eo .4yan-eda_, c�2 /4s Pula.�� s `2 O. 13 L) 5-8/ l <br /> .Sam 7M14-eo , (/ gg4'0 3 <br /> Owner Phone: �Zoq) ,4 Zz _ /&g g Operator Name : C3ura i ry <br /> Operator Phone : g p ) 8'2.3 -4 7/5 <br /> Contractor Name : p- �v Odqrvss 209 2 99 - 5-/0 5- <br /> Classification : <br /> Classification : License No. : o?/ / <br /> C—u fe l�a n c*--O mz-7-t-0. <br /> Laboratory: <br /> DHS Certification No. -} - Category: (gyp-yyr ��- Way, <br /> /0,8- <br /> Tank (s) : <br /> U�Tank (s) : <br /> No. of Tank (s) : Type : JkU ja <br /> Size: dpprpX. 2 Q jaa Type of Product Currently and/or Previously <br /> Stored:- <br /> Amount <br /> tored:-Amount of Product Remaining: pzz�n? How Purged: <br /> Distance to Nearest : <br /> Septic Tank: B ldin • Property Line : <br /> Well: (See Enclosed Plot Plan <br /> Tank (s) Reuse : <br /> Nature of reuse : <br /> Location: --- <br /> Future Owner/Operator (if applicable) : — <br /> Tank (s) Disposal : <br /> Method of Disposal: si 2i h ,u�td <br /> Enclosures : <br /> Plot Plan <br /> Contractor ' s Certificate of Workers 'Compensation Insurance <br /> "Release of Authorization" Form <br /> Brown and Caldwell Consulting Engineers <br /> 723 S Street, Sacramento, California 95814 (916) 444-0123 <br />