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4 <br /> Oct 20 03 08: 57a P. 1 <br /> Amok <br /> jj;.SjjN(;0V I?A'1?j;jj(;jj()jjjvj) 7iIIVKSA7*,,11;'I;tyl?I)AIIII.'I(.47'P*.'V' <br /> UY 7Y4-0112 <br /> Port Offlce Box .16 7*1ijimfort, (21150) 794-0102 FAX 794-0112 <br /> ly M..".Name: <br /> 20> " w Yo <br /> ,�F. <br /> Site Alclorst: __ . <br /> -V <br /> _9 LKVft ( <br /> rVilike/hiqlairl lit MI'll;I(Itillp Syricill, <br /> 11. Invelslos,Y of <br /> (.]beck the a in late®oats In lisdicuiv.t edits r ill <br /> It. ;Z- <br /> 0--4 <br /> Ll In-,I,mlk Unilp 19 <br /> Tank 11 _ � LI lot 1 link 4 IftnRIBIP I'tt'lw <br /> holt I'FlAw 'P" -7 .,A,0 A4 <br /> ')-14 Aninifill SIlftt*r M V.Illt Srovtm. <br /> 110. -_ <br /> cl Atintelar 01 V"ll" .1''Sell n"I(4 1 <br /> U riploolt Swololl,/ I ":Irl' or"' <br /> L) F-111 slo"llp lJ Pili Sloolill So­ll-%-,q(-%I- <br /> U I.Irle I rook I lo-Irelsw MINIA.. <br /> U Mechanical I.,Joe I rnk I Iroerom 11,1111.1fel. U I'letlefPstic fjoir Least I weer,""- MCHIel: <br /> 0 P U 'I alk Overfill/Ifigil"A'-Vrl Sr'lltn"' <br /> ,jectwOnic Line Lenk I)rlrclfvr. KIC-def! Mqxlei! <br /> 0 Tank oveinu I ligiv-1,eves Senstly. m4loirl:- . . c Oter 9 cif C ell I t-3e and RIXACI 10 Suction d3 an EW-2). <br /> I t and model in Seclitoll 1:till Pro, Uh <br /> III <br /> Odra talk 1 " _. , 'Il"'l' "oce.f lank ..w ko—----- <br /> 05:11 - U I 'I milk(I <br /> TalskIlh— it ifloopillft Petiole. <br /> 0 in-Took(1111191119 Pfeifle- Im <br /> U Annular Spare at Vault seligill. a U AnoillInt S1111111-C Ili Volikh Sciostir. Model: <br /> U Piping Sump/Tictich Sell'ClIFI1, Nit KIII11cf: '21k PT U Itillilig sullill/Tiellch sentoo(q) MOtle.l: -7 <br /> mottirl. U Hit Skinlit Sell-Rill(v) <br /> U nit sunip Senienri(q). rot I)r1reltil. mliclel. <br /> U Mechanical Line I znk Delectill. N114,00. U hirril"llivell I jilt'.I <br /> U Electronic I J ne Lenk DelerIl it, KilItIrl: U pleril(inic 13"e Lornik I'lelief"14111- Model. <br /> Ll Tank rivellill I lligll.levrl Senotm. M-Irl- U 'I knife IlIvrorill I Iliftio-1 level selliefir. Model: <br /> O(Xha(:Spg:=g,fUS&Uigpqmllenlot&ylLle Issid IIKKICI ill Sections U till I IlloOdel in Section P.On P <br /> Liu Lll­lj_;�" I metal l >e and <br /> calsock acks Tank ID: <br /> FDTank - U In.'rouk(Inuging 1'1(tltr. Model: <br /> 0 in-Tank(7,insging Pr011e. Spacetit V81111 Sensor. moilel. <br /> (3 Annular Space OF VIII'll Sensor. Witlel: 41�—_ U Arsonists <br /> U Itilling SlOnli,/'I*l rtich sengfir(s). Model! <br /> El piping Sump I TrenchU ndrtt Vill silloolb sellstsl(n). Moldel:- .. , I <br /> 0 111$Sunlit Sen"I"(0- U hirrhowlicul Thee I elk DrIerlill. Monfel: <br /> U mechanical Lble I tnk I Irleritil. Mndrt Mildel:------- <br /> 0 Mecoonic Line Leak Detector. Mildel!, U plecloollic I file.trait [10clot-lilt. Model' <br /> U Tank Oveffroll I 111911.1 level-Sconessit' 12). <br /> D Tank Overflil I I ligh-[,Cvcl Sections- Model: Ll Other(specifY Ililolllcril I <br /> if up]client I and model in Section E till Pre Tank 111). <br /> 0 . U hl-Tank 4ioulgillil I'llITE <br /> Tank ID: ttlCModel- <br /> • In-Took Gauging Ill 411m- MIo4IVr.)*1a--Y 1 7�w U Annular Space err Vistill Se'llstle" Madel: <br /> • Annular Space lot Vault Sen-Int. moticl:SIP,I Trr4­o ar, U llill;llg Sump I Trench Model: <br /> CI piping Sump/Trench Ser'S11*11. Madel: ;;,�75FIDU Fill M(KIC1. <br /> U nil Sump;screant(.,l)- mqttlrl. U Mel-linnit-ol I.ine frisk Ilriertill. Mtoolcl� <br /> U Mechanical line Lank Dr.leclfbf. M4.410. U Ille(qlinlic lJoic Leak I lefort-11(il, Mcidel. <br /> El Electronic[Ane Leak Deteclill. Moldel.. U'I'nnk Ovetrill/111911.1 cvlrl Se"NOt. Mskcicl� <br /> 0 Tank Overfill/ltigil-I xvrt selsokoll. M111107. j of ecif i 1111cul I le assil ussidel In Section pastiL_1 <br /> m due—.cgp�tfv malmimpt typt mold smkidel it,Secli011 V 11 at the facility. <br /> If the facility contain/smile tanks Or dhIllIC-1190111-C4111Y 111'%(411 lit Incholle infutniallon lilt every nkentillixivenser accordance ram' <br /> les tltls well Was <br /> it lit ordance with the"Omfmdu <br /> C, CerfirlCOH011-I cetilrY that file sidli'll"lle"'lele"1111"41 Is clircklisix) necemary 10 verlry "I ibb Wonsvdko 19 <br /> guidelines. Attached to this Certification Is Inforisinflon fe.g. 11121111 For any colulicteekelowl colIpplile of generating such I hbvG sleall <br /> coarrtd and a not Flan showing the IIIYOOI or nmerain,Ile((riltiollinwini. <br /> tl*CW a copy of The repari-,(ehork grit t1cal apply): Ll Svielens coet-wels; U Ala tee <br /> it 4.01-w till <br /> Celli ticket is Ili Nil:. Homer Nil bas <br /> ------ <br /> l <br /> Testing('111111intly Natit: <br /> Page I of 6 OCT <br /> mollitiorbig%yo;ieltl Cre-fifivis tick's - <br /> MAI <br />