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Date : a a 98 <br /> r �;:�11 tWs�'+�::✓ �„SII' �{� <br /> PERMANENT CLOSURE/TANK REMOVAL PLAN : <br /> ENV[kv", EN-TAL HLEALTH <br /> Facility Name : <br /> FERMIUSERVICLS <br /> �}-��� �,`N��, S�Z�-iox (pOzC7 <br /> Facility Address : / 7/( ��p� ���Qyh�'�-e �j/�h- .�a7 (°A 9533( <br /> Owner Name : no P7 <br /> Owner Address: 20()o 4janrelos Bo)( 58/ 1 <br /> SaH pct-{-Pa (fO-e i h-rnici 94u 0 3 <br /> Owner Phone:�Zog) ,qZZ - J(,8 8 Operator Name : Burt i ry <br /> Operator Phone : (!, pq) <br /> Contractor Name :4011m- oq) ;Z99 - 5105 <br /> Classification : License No. : <br /> u re l�a.- LGt b ora , 5 a c ru m,e rte. <br /> Laboratory: ,.r�� r �� t=-, <br /> DHS Certification No. Category: <br /> /Og <br /> Tank (s) : n <br /> No. of Tank (s) : Type : f Gam' <br /> Size: dpproX. g � Type of Product Currently and/or Previously <br /> Stored:— L4),,)- <br /> Amount <br /> 4 ),,)-Amount of Product Remaining: nlone How Purged : <br /> cY� rc� <br /> Di t nce 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: Sr 2i h .and H. <br /> �Cr 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 />