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' �E�����'� ��F W--������ OFFICE OF�N��EMENTAL HEALTN • 590 HAMlLTOlV STR�R�DWOQD CITY,CA 94063 <br /> (4i5)363-43t}5 <br /> GATE Z�(�'fl� ����x • . <br /> I .RFC�iPI �t .._����.--.-. 'APPLICAT��N FOR PERM�T T ABAN�ON <br /> I� ��� � � 3 p : UNi3ERGROUND HAZARDQIJS ST � E TANK � <br /> f. Facility tnformation � ' � � . <br /> Name o!Fpc�bry • . . lypc o18u�fness , � , , . <br /> �., v• ' ?`.t.. b� �r.�. .�t�G��� <br /> SiruclAddrQSS Cdy ZpCntis 7e[epiwne <br /> ` � ` <br /> � � � G � . �. <br /> Canlract peclaU Pa lion wiih Cqmp�ny , Tulephaslo . <br /> Owncrs Name ICOtporallon.Agency,oc Indiv3duap . ' <br /> J i'^� � <br /> � fiflae:Addross{ll0il r �ha bova) � • Crly . TipCoda � Telephone <br /> .�.5"/� d� �z�,� �J S3 �s=f��v-�3z3 <br /> 2. Contractor Ramoving 7ank <br /> mpany Namn Str��l Add[es» Ciiy 7alephoqc <br /> C �[b�w�%�G G ` m ,1.,� CJw b�z6 S`-Z6 <br /> 3. Soli Anafysis Labvratory � ' <br /> Caropany Nams Slreai Addrass City Telophorw <br /> , �-TT . 1r�7�c� ��.s�� Gr�tc..c.. - <br /> 4. Hazardoas Waste Hauler(if a��roprlatej , , , , <br /> 1 <br /> Company Nama , . � , SSreek Address Cdy Te1ep€fone <br /> I �i / . . I <br /> 5. 7ank Identificaiion&Construction , <br /> . I <br /> Tank�aULY YuarTanklnstallcd ValumoolTankiGalloa} GatnodicPmiectlon <br /> ,�,..--_ a�'��.ZdtrY+ <br /> �� 1-- (poo _ • • � �7 fVo �Yes,Type . <br /> PrMaryCVnla�nntQni �� - . . ., , � I <br /> � Cancrete LT Steel f� Fibergtass O �ibergEasslCoated Steel CI Oiher: <br /> B. Chemical Composition of Materials Currenfly or Previoe�sly Stor�d in 7ank <br /> currunlly previausty � Chemlcal Do Nat Usa Commercfal Namo {Use addcllonal paporla moce[oomk <br /> slo�ad slorud CAS N[if knavra) ' ' ' • � <br /> 061 002 � . <br /> . ❑ pt 062 <br /> 0 U1 Q 02 . <br /> 7.Piping . <br /> A. A6ovegrouncE Pipir�g: � uE poub[e-walled pipe �az Concret�-IEned trench ❑ os Gravity C7 aa Pressure �as Suctfon <br /> [(Cheak) aPpropriate box�es)] �oa .Unknown �] �r IVone <br /> B. Underground Piping: � o� Double-waUed pipe Q az Cvncrete-lined trenah � oa Gravity �a4 Pressure C3 os Suction <br /> [(ChecEt)appropriate box(es)] ❑os Unlsnawn E7 m None <br /> i <br /> 8. Disposi#ion of TanEc(s} � ' <br /> Proposnd Olsposijton oS Tanlc�a) Roason lor Aemoval ' <br /> � <br /> ' 9. App3icant]niormatian <br /> ' Na of Apptfcani -�� Sl�na of 1� t J ,� �7atn� ��� <br /> . cC�v rs�v �'� r ' <br /> . S72Q-34 � <br />