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Date < <br /> PERMANENT CLOSURE/TANK REMOVAL PLAN : <br /> EPvVi..,-. .,��,�at_ , LTH <br /> F ERMIUSERVICtS <br /> Facility Name : f}� 'LQ ��.N� S fjozc (00:Z0 <br /> Facility Address : /7// Sz;"/-�-e -kp76(114e, _ � �I A 8533(, <br /> Owner Name : P <br /> Owner Address: 0 58/ <br /> "So,u -7y,-14-e o . � q4 c! 0 3 <br /> Owner Phone: - _ Operator Name : C Burai� <br /> Operator Phone : 2p ? 8'2.3 -47/5- r <br /> Contractor Name : 5vto Ss zoq 2 qq - 5/0 <br /> Classification: 9 License No. : <br /> Laboratory: E-urel �" LG(bo-rq , 56LCr-O .crt�o <br /> DHS Certification No. .-}tw#-- Category: <br /> /Og <br /> Tank (s) : <br /> No. of Tank (s) : Type : /yU OJ <br /> Size: QppraX. 2 p qQ Type of Product Currently and/or Previously <br /> Stored:— <br /> Amount of Product Remaining: nr&no How Purged: <br /> dry i cz <br /> Dis ance to Nearest : <br /> Septic Tank: Building; Property Line : <br /> Well : (See Enclosed Plot Plan <br /> Tank (s) Reuse : <br /> Nature of reuse :- <br /> Location- <br /> euse :Location: --- <br /> Future Owner/Operator (if applicable) : -- <br /> Tank (s) Disposal : <br /> Method of Disposal : c/ si 2i r .a i <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 />