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Date —, <br /> PERMANENT CLOSURE/TANK REMOVAL PLAN : <br /> FEl MIT/SERVIOLS <br /> Facility Name : f}�� -52,✓I/�C.2 SfLt�iok &0Z6 <br /> Facility Address : /7// E--Gtj+ Svw _j-e A,4_CCa_ � /'�lq g533(, <br /> Owner Name : P <br /> Owner Address: o 58/ <br /> .Sah 7/1ilcr deo , �' i�urrlici D 3 <br /> Owner Phone: _ Operator Name : �- <br /> Operator Phone :) gZ3 -47/5" � �X-4 n�a <br /> Contractor Name : 5k1 sszoq 2 q9 - S/o <br /> Classification : License No. : - / ,12 / <br /> �u ,a�n�Laborq fd>- ; -5 C '�cmcrt�. <br /> Laboratory: ,s;� A0 U <br /> DHS Certification No. Categor' j <br /> /O$ <br /> Tank (s) : <br /> No. of Tank (s) : Type : IyU <br /> Size: Qppa)C. 2IEOO; <br /> Q Type of Product Currently and/or Previously <br /> Stored (A)ns/ / <br /> Amount of Product Remaining: y1pne How Purged : t_4tq46*X <br /> dv- 1ce- <br /> Dis'E nce to Nearest : <br /> Septic Tank: Bu' ld' 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: r-e_� and <br /> 150 i '.5 v 0 s rr <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 />