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Home My WebLink AboutUNDERGROUND TANK-C-02/16/90PROVIDE DRAWING OF PHYSICAL LAYCUT OF r.~nT~ ,'~, - ...... =i ~ USI~: , SPACE PROVIDED B~W. Afl. OF ~ FO~wIN~ I~O~TICN MUST BE INCLUDED ~ OFFER FOR ~PLICATION' ~ BE PR~S~: /T~(S), PIPI~ & DISP~SER(S.), INCLUDING ~.~S ~ DI~SIONS ~ PRO~S~ S~LING ~ATICNS DESI~A~D BY ~IS S~L "~" / ~T ~ OR I~E~ION ~ ~ ~ WA~R ~.rS OR SU~ACE WA~ WI~IN I00' ~IUS OF FACILI.~ FILE CONTE.~ITS SUMMARY ~NV. S~NsITIVITY: Activity Date # Of Tanks Comments j.O. BARBER TRUST 300 ! BRUNDAGE LANE 2700 .-.~' KERN iN,T'f AIR POLLUTICN ET,.~TRCL DIS T ,i ~'" 2~n~ "M' , Su, 275 ~ .' ~ak~rs~]d. CA.. 93301 I ' (BBS) 861-3682 I ~, ~E I VA~R RE.VERY INSPECTI~ FO~ ................................................... c :,, ..... -: ...................... .~ ................... ~, ~._ . .................................................................. :// ~ - , :,?:, .. .. .'.... [ 1. P~CT (UL, ~L P, or R) ~ .'.. 45te,~,',- ~ : . ,.: ~( 3 B~K~ OR MI~ING VA~R CAP ":~"": .... . . :::. :¥,,'?~.,~¢:~S~: ...... . ': :.,~,...:::~'.': .:. , :~ ' 4 B~K~ OR MI~ING FILL CAP ~-~;'"'"" '{'-'::~' :.:.' ~ B~K~I C~ L~K ~ VA~R CAP . ' ~ ~ ~ mROm:mLY ~EATEO ~ ~. ~LL ,,~P.: NOT ....... ~ VA~ C.~ NOT F~OFERLY ~EATEO ~ 8. ~SKET ~I~iNG F~M FiLL CAP J 9. ~SKET MIS~ING F~M VA~R CAP IF t ~1. VA~R '~ ~'' ~ '- I~ .Au4., ~(;~ NOT '~ ~.U~.~'OP &FZLL ~ ~- GASKET ,=~'~4;=~,_,~ ~,, '- ....... f VJBE ~i~.iG /' [MP~CFERLY ~EATED I. ';3 . ~'~'"_..,, .~RE.-.. ';.~SK¢~3 .... O~ER : ' 5 ....... .}~7-'~ , =*< .c:;:,,~.=~, T -.~ ' 7 TUSE I~TH g. "D'T:,m ER ',n:,~ CCIV~dEF, T3: _ PO~-LU, ~ :NA~NING : S'fSTE~F~ ,',lARKED WITH A CHECK ABOVF ARE IN VIOLATION OF KERN COUNTY AIR ' ' -~-,~ CCNTROL DISTRICT RUL.'--(3) 209, ,z!2 AND/OR 412.1, THE CALIFORNIA HEALTH A SAFe'Pr CODE ~;x:::~,~'~ SPF_.CiFZ.--S .:'-~NA~LTZES OF UP TO~ $1.000.00 PER OAY FOR EACH VIOLATU,.~ .TEL.EF~.:ONE. ,,,m,:.,:,. 861-3682 CONC,-RNING FINAL R,'-'=J]LdTiON OF THE V!OLATiCN(S) GARY J. WICKS " 2700 M Street, Suite 300 Agency Director Bakersfield, CA 93301 (805) 861-3502 . - Telephone (805) 861-3636 · ~.~.,'.'!.!.i? .~' ~.'.~ Telecopier (805) 861-3429 RESOURCE MANAGEMENT AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH SERVICES February 16, 1990 John Barber P. O. Box 11147 Bakersfield,. California CLOSURE OF 1 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK LOCATED AT 3001BRUNDA6E LANE IN BAKERSFIELD, CALIFORNIA. PERMIT # A1096-27/270014 This is to advise you that this Department has reviewed the project results for the preliminary assessment associated with the closure of the tank noted above. Based upon the sample results submitted, this Department is satisfied that the assessment is complete. Based on current requirements and policies, no further action is indicated at this t~me. It ~s'lmportant. to note that this letter does not relieve you of further responsibilities mandated under the California Health and Safety Code and California Water Code if additional or previously unidentified contamination at the subject site causes or threatens to cause pollution or nuisance or is found to pose a significant threat to public health. Changes in the present or proposed land use may require further assessment and mitigation of potential public health'impacts. Thank you fo/r-%y~r cooperation i~ this matter. TuRONDA R. CRUMPLER, R.E.H.S., HAZARDOUS MATERIALS SPECIALIST cc: RLW Equipment "'~' ENVIRONMENTAL RATO RI ES, INC. PETROI. EUId J' J' EGLIN, REG. CHEM. ENGR. qERCE RD., . BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 RLW EQUIPMENT Date Reported: i2/14/89 Page 2080 S UNION Date Received: 12/06/89 P 0 BOX 640 Laboratory No.: 9667-1 BAKERSFIWT.n, CA 93302 Attn.: BUD MCNABB 834-1100 Sample Description: 3001BRUNDAGE LANE CENTER OF TANK 2' TOTAL CONTAMINANTS (Title 22, Article II, California Administrative Code) Method Constituents Sample Results P.Q.L. Units Method Ref. Lead 6.22 2.5 mg/~g 6010 1 TOX None Detected 20. n~j/kg 9020 1 Oil & Grease 32. 20. mg/]~g 413.1 2 (See Last Page for Comments, Definitions, Regulatory Criteria, and References) RecjulatorM Criteria Constituents STLC, mg/L TTLC, mG/k~ Lead 5.0 1000. Co~aent: All constituents reported above are in m g/kg (unless otherwise stated) an as received (wet) sample basis. Results reported represent totals (TTLC) as sample subjected to appropriate techniques to determine total lew~]$. P.Q.L. = Practical Quantitation Limit (refers to the least amount of analyte detectable based on sample size usedandanalytical technique employed. N.D. = None Detected (constituent, if present, would be less than themethodP.Q.L.). I.S. = Insufficient Sample STLC = Soluble Threshold Limit Concentration TTLC = Total Threshold Limit Concentration REFERENCES: (1) "Test Methods for Evaluating SolddWastes", SW 846, July, 1982. (2) "Methods for Chemical Analysis of Water and Wastes", EPA-600, 14-79-020. ENVIRONMENTAL LABORATORIES. INC. i~ETROLEUM J.J. EGLIN, REG. CHEM. ENCR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 RLW EQUIPMENT Date Reported: 12/14/89 Pa~e 1 2080 S UNION Date Received: 12/06/89 P OB OX 640 Laboratory No.: 9667-2 BAKERSFIRT~, CA 93302 Attn.: BUD MCNABB 834-1100 Sample Description: 3001BRUNDAGE LANE CENTER OF TANK 6' TOTAL CONTAMINANTS (Title 22, Article II, California Administrative~ode) Sample _ReSU~S~.. P.q.L. Units Method Ref. Constituents Lead 2.5 mcj/kg 6010 TOX None Detected / 20. mo/kg 9020 Oil & Grease 20. mo/kg 413.1 2 (See Last Page for Comments, Definitions, Regulatory Criteria, and References) RecjulatoryCriteria Constituents ST[X], mg/L TTLC, mg/k~ Lead 5.0 1000. .Comment: All constituents reported above are in mo/kg (unless otherwise stated) an as received (wet) sample basis. Results reported represent totals (TTLC) as sample subjected to appropriate techniques to determine total levels. P.Q.L. = Practical Quantitation Limit (refers to the least amount of analyte detectable based on sample size used and analytical technique employed. N.D. = None Detected (Constituent{ if present, would be less than the method P.Q.L. ). I.S. = Insufficient Sample STLC = SolUble ThreshOld Limit Concentration TTLC = Total Threshold Limit Concentration REFERENCES: (1) "Test Methods for Evaluating Solid Wastes", SW 846, July, 1982. (2) ,,Methods for Chemical Analysis of Water and Wastes", EPA-600, 14-79-020. BY 11/29/89 Invoice Nbr} 1 25005'1 '. ' ~.-4 .... .... .... J. ., . ...'.' .',: , - --', ....,.. "..........' ......... ' .'. :.., . .. · ,' .. ....... ,, ..::.. ,.~,~,, :,~,~..:.,/,. I Customer P~O,t Urn 8y ~O~er Date Ship Date J · via. I"Ter'm I TANK PLAN CH~CK 1. 100,60 ~ 100,00 OPdeP Total !00, O0 P,yment M~d~ 8y Check !00,00 THANI~ YOU! RAKE.FIELD, CA 93301 (805) 861-3636 ~OSU~/A~ANDONHENT O~ UNDERGROUND HAZARDOUS SUBSTANCES STORAGE ~lS APPL;CATION IS ~OR ~'RENOV~L. OR PROJE~ CONTA~ jPflONE ~-~)-/~ ~ ~SEC/T/R iRU~ LO~TIONS ONLY) RACI~I~ NAME '. TANK · VOLUME C]i~I~L ~RED (NON-CO~ERCIAL NAME} DA~S ~RED ClinICAL PR~TOUSLY ~ORKD WATER TO FAC:~ PROVIdeD 8Y OE~R ~ GRO~AT~R BASES FOR SO[~ ~PE ~D GROUNDWATER DE~ll DETE~INATIGN / T~KIS) PIPING [ ~ ~ t Date Rec'd: ': BC CHAIN OF CUSTODY NO. L- 3.9 4 Client: Sampler: A~,//. ~,~tg~.~.<, Sample Type: Analysis Requested: Name: Name:' Water Other: ~ ~ ~ ~ ~ ~ Ad.ess:_, -Ad.ess: ~/O0-~~d Soil .~ (specify) -- ~ ~,~ ~ ~ :~ Attn: a ~Oil o ~ i E ~ Lab ~ Description: ~00 / ~ n ~- Other Tests ~ Relinquished By:~ Date: Time: Receiv~ By: Date: Time: Comments: //f ~ Yello.w: BC Lab Copy .~ KE~N ~ AIR 20 ..I~TION CC~TROL ~. : , ~E II VA~R RE'VERY I~*EOTI~ FO~ ..................... : .......... ~ .................................... . , ~ ~ .~s ,~o~ t ~ NOZZLE ~PE ...... ,. [ 0 3. 'FACE S~L ' '. Z Z 4. RZNG, RZVET 0 3 CCNF iGU ~ATi C~4 R ' " ;"~ ~ I ' '- .... ' ~ i i-' '~' '~' ; ' ! '~' ' t' , 't' 8*.~a]ance ..:>'c~: ~ Key :a def~cff~,cff~: NC= na~ ,:er~fff'f,~, ~= broken :~ INSPECTICN RESULTS ~ '.~'e¥, :: ir, zoec~icr, ~msui~.~: !~lank= '.}K, 7= Re~,~ir w'i~b.~n :s~ven ~ V~O~T~CN3- SYST~ ~RK~ N[~ A "T" ~DE IN ~NSPECTZ~ R~LT~, ARE IN V~O~T~ OF ~'~E~%~r'A~R ~LLUT;~ C~T~,L O~S~RZCT ~LE(S) 412 ~D/OR 41~.1. ~E' CAL~FO~ZA ~ H~L~ & SAFE~ ~DE SPECZF~ P~ALZ~ OF UP TO $1,000.00 ~ VIO~.,I~. iELE~E (805) ;361-3684 ~CE~ING FINAL R~LUTI~ OF ~E VIO~I~. NOTE: CAL[FO~A H~.L~ & SAF~ ~DE SECT~ &1960.2. DEF;C~C~ 8E CORRECTED NZ~N ? OAYS. FA;LURE TO'~PLY KERN COUNTY RESOURCE 'MANAGEMENT AG ENC%- ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2?00 "M" STREET, SUITE 300, BAKERSFIELD, CA.9330! UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY ~ INSPECTION REPORT * PERMJ'T~ ! 'TIME IN /..~Z,_.¢.....~..... Ti .OUT ......................... NUMBER OF TANKS: ................ ~ .............. ~ .... PO5 ' YES ..................... NO TYPE OF INSP:~' ROUI'~NE:L ...... ~. REINSPECT!ON' COMPLArNT FAC ~ r 8~KERSFZELD FIRE DEPT. STATION ~9 ..... I.., TY NAME: ........................................................................................................................................................................... ~ ....................... BAKERSFIELD, CA COHHENTS: V I OLAT I ONS/OBSERVAT IONS ~ PRIMARY CONTAINMENT MON~TORrNG: d. In-tank L~vei Sensin~ Device ~ECONOARY CONTAINMENT MONI,OR~dG: L~n~r b. Ooubl?~a!ied tank s. Vaul s ~. ~rassur~zed ~ 3ucdon c. - , .... ,]ON:~TRUCT;m i',h~ nt .... - 8. UN~THO~[ZED OPErATiNG CONO[TiON 0F,:~rm'v~,~,,, State of California---Health ,.nd Welters AW~ See Instructiorl~[: ,;k of Page:6::::~" _/~,'D. eOartment'~l' H~lth Sen, ice Toa~ Incee, Control Divisic For~ Approved OMB No. 2050---(X]39 (Exp~r~ 9-3u-91) and Front of Page 7 /"--/ Californ, Please print or type. (Form designed for use on elite (12.pitch typewrite~'), i -- UNIFORM HAZARDOUS I" Gen..a,ors US EPA ,O No.' .... Man.es, . . I ~r~.~,~. ~.th.~ed a~.a J: Additional Oe~ipt~ I~Matedals Listed ~ove ~ ~n~l~ ~s I~ W~Ies ~st~ Abov~ ' and are classified, tacked, marked, and labeled, and are in all respects in ~ro;er condition for trans~o~ by highway accordin~ to a0plicable international an~ ,, na!ional government regulctions. If I am a large quantity generator. I ceni~ that I have a Drogram i~ place lo reauce the volume and toRicity of waste generat~ to the degree I have dete~ined ~ to be and t~al I have selected the ~racficable method of treatment, storage, availaDle to w~ich minimizes economically ~racticaDle disaosal cunent~ me present and luture threat to human health and the environment; OR, if I am a small quantity generelor, I have ma~e a go~ faith eff~ to minimize my waste generation end select Ihe best waste management method that is available to me and that I can 17. Transpolar ~ Acknowledgement el Receipt of Materials 19. Discrepancy Indication Space F ' A C ~. Facility Owner or Operato~ C~ificalion of r~eipt o~ hazardous materials covered by this manife~excepl as noted in Item 19. ~ 8022 A (I/~) Do Not Write Below This Uae ~" ,~i 270o M Street, Sulle 3OO GARY J. WICKS ~., Agency Director _ .' . . ., .... ." · Bakemfleld. CA 93301 . (805) 861-3502 . . · ' - . : Telephone (805) 861-3636 '"" , ..... .. . "". ~,. :, elecopter (805) 861-3429 '.'. · STE E McCALLEY -' ~ · ': ~.. ' ~ ~ '~'"': :~ '?': DEPAR~ MENTAL "~'~" ,:~ PERMIT FOR pERMANENT CLOSURE ;?' '7 ?PERMIT NUMBER A. 'I096-27 :~.t., · ~?',:. , , .. . ,, . ~: '.', "::~ SUBSTANCES STORAGE FACILITY:.,'~".~.~: . FACILITY .NAME/ADDRESS [$) .NAME/ADDRESS:': :~'i~:- ''~' £: TrU: LOCATION Ha~rdous Materials Specialist CONDITIONS AS FOLLOWS: " 1. It is the r~ponsibility of thc P~mitt~ to obtain permits which may be r~uired by other rcgulato~ agcnci~ prior to bc~nn~ng work. 0.e., Fire and Building Departments) 2. Permittee must nq.~ify the Hazardous Malcrinls Management program at (805) 861-3636 two working days pdor to tank removal or abandonmc~ in place Io arrange for r~uircd inspections(s). 3. Tank ~l~urc activiti~ must be per Kern County Environmental Health and Fi~ Department approved moth.s ~ d~c~bed in Ha~db~k UT 30.- 4. It is thc Contractor's r~ponsibilit7 to know and adhere to all applicable la~ regarding thc handling, transportation or treatment of hazardou materials. , 5. Thc tank removal contractor must have a qualified company cmplo7~ onsite supc~ising thc tank removal. The empioy~ must have tank remov: . experience prior t0 working unsupc~ised. 6. If any contractors other than thee listed on permit and permit application arc to be utilized, prior approval must ~ ~antcd by thc speciali~. listed on thc permit. Deviation from the submilted application is not allowed. 7. Soil Sampling: . - a. Tank size 1~ than or ~ual to 1,0~ gallons ' a minimum of tw° sampi~ must be retrieved from ben.th the ~nl~ ~ the ta'nk at depth of approximately two feet and six feet. : ' ~ '" b. Tank size greater than 1,0~ to 10,000 gallons - a minimum of four sampl~ must bc rctri~cd one-third ~ thc way in from the ends each tank at depths of approximately two feet and six f~t. c. Ta~k size ~eat~ than 10,000 gallo~ - a minimum of six sampl~ must be retrieved on-rough of'the way in from the ends of ~ch tan and beneath the center of each tank at depths of approximately two f~t and six feet. g. Soil Sampling (piping a~a): , _. .(.: . A minimum of two sampi~ must be retrieved at dcpihs of approximatcl~ two fcct and six fcct for cvc~ 15 linear f~t of pipe run and under dispenser area. / · PERMIT FOR PERMANENT CLOSURE ' ' " PERMIT NUMBER A' 1096~27::,' '.. X, OFsuBSTANcEsUNDERGROUN.DsToRAGEHAZARDOUSFACiLITY ' - · ~ -_ : . '" ADDENDUM.. _,. -:,: ' · : · .-'"' and total petroleum hydrocarbons (for gasoline). ' .- ' ' .. ..... :. - .. · · b. All soil samples retrieved from beneath diesel tanks and appurtenances must be analyzed ['or total petroleum hydrocarb, · ;, .,": ",' :' .;.'.'~;~ ' ~:i~.. {~- /~c: , ...- ~AI! soil samples retrieved from beneath waste oil tanks and ai~purtenances must be analyzed f~- total ori~fii~ i~hliaes,'lead, ''i."; 7 G,.~' '~,,' !'.'z 7,:;.,'; ';:'~': d. , :Yi'~,AII soil samples retrieved from beneath crude oil tanks and'appurtenances must be analyz~l for oil and ~ease.- ":¢4'-"..c':! .::': '";' '?; "', "; ",~;~.?:'~ ~. '.. Q?Aii soil samples retrieved from beneath tanks and appurtenances that contain unknown Subsia'~'c~s must-be anai);~ed' for - ' '." ........ ' ...... substances that may have been stored w~thm the tank. ' ' : ..... ' ' ...... : .:... 7,-:" '?' 5' I0. following timetable lists ·p' .:-,. :... . ~ ... .' '. ,".~ !'~? ~" 5? .." ~ ". ' Materials Management Program. All hazardous wast6" _ ~ . · ~:days'for the tracking form after'{ank removal "--". ' manifests must besigned by thc receiver of the :.'~- :=::.'!"-- .:.%,.,.:;.~:~. ...... ~-.. .... .... _.. · ' . , · ,,'. i.L' -: --.. - .' .: . .... hazardous waste · - . ' ' : '-:. ~. - "-: i i : ~,., ' ,' .. j'. :~,..~ '-,,:-~ '; .' ?,:: ,. ,...- '... '.. ~. ,,. ,. ....';.'.' ~',, · · ' ,,,~:~! c". ~'~ '.,~!;;~.,~4 '~ ~ ' · '- ' ':"'"a "':'"~ "· "'.' -: , .,... ,_ ..,: ,':, ;. ~. ,, :; ~ ,?; ~:~..Sample analysis to Hazardous Mal~als Managcmenl ,,, ~:z .,;. % ,,, .,~ ~ ,~, ,,.No iat~ Ihaa ~: ~rkmg ~ afl~, ~mpletlon o[ anal 11. Purgmg/In~rtmg Confllt~ons: ' - ' · ...... ' '-' ... - ' ' a. Liquid shall ~ pumped from tank prior to purging such thai I~s than 8 gallons ~ liquid ~main in tank. (CSH~SC 417 - b. . , '.. Tank shall be purged through vent pipe discharging at leasl I0 [~t a~ve ~ung I~. (~H~SC 41700) '~',;(~ }., "' ' c. ' No emission shall ~ult in ~o~ det~table at or beyond property line. (Rule 419) ,k'. -' , 5'.~.:, ~-.:,..,:? ':~(,~;~,., :i d. No emission shall endanger the hcallh, safely, comfort of rep~e of any pe~n. (CSHaSC 41700) ' ': ' ~' 7 . ~. - e. Vent lin~ shall remain aHached to tank until the insp~tor arfiv~ to authorize ~ovaJ. ~CO~NDATIONS/GUID~INES FOR ~MOV~ OF UNDERGROU~ STOOGE T~KS ." '. ': This depart'meat is r~ponsible for enforcing the Kern County Ordinance Code, Division ~ and state ~gulaflons pertaining to U~dergm~nd Repr~enlaliv~ from this department r~pond to job sit~ during tank removals to ensure that the tan~ a~ s~e to ~move/cl~e and 'job performance is ~nsistent with permit r~uirements, applicable laws and safety standards. The follo~ng guidelin~ are offered to clarif' and expectations for this department. 1. Job site safety is one of our pfima~ concerns. Excavations a~ inherently dangerous. It ~ the ~ntractor's r~ponsibility to know C~-OSHA regulations. The job foreman is r~ponsible for the crew and any subcontracto~ on the job. ~ a general rule.we permitted in improperly sloped exeavatio~ or when unsafe conditions exist in the hole. T~ls and ~uipment are to be used only for function. For example, backhoe buckets are never substituted for ladder. ";. . 2. Properly licensed eontracto~ are assumed to unde~tand the requirements of the permit i~ued. The lob foeman is r~ponsible abiding by the conditions of the permit. Deviation from the permit conditions may r~ult in a stop-work order. 3. Individual contracto~ will bc held r~p0nsiblc for lheir p~t-removal paperwork. Tracking forms, hazardous-waste manif~ts d~umentalion is necessary for each site in order to cl~e a case file or move it into mitigation. When contrac[o~ do nol follo~ nec~sary paperwork, an unmanageable backlog of incomplete cas~ .r~ults. If this continu~, prying time for completing new increase. - ~N~R OR~O~T' -' . ' ' DATE ' TRC:cas ka1096-27 . , , Bakersfield, California g3305 Telephone (605) 861-3636 -: .-~:: :holde~ 'of. the ~permit '~i'th ibove' ts res ' i ,-.-- ,'-~ ..... .. ~ ....= ' ~" ' . />'~'.~-. .form )feted ~d · .:,' ' ,-,.Address :.' ~ ~ ~;'~'~//~'""'~,/* ' :-'Ph°n~-~=~~-'Tg:- ~:~,':~¥: · .., · . , . . ... : ,- . ..: ;~: .~;~<~.,.,~ ..... ,..~ _.. . < . ... ~.~ ~.~ ,~. ~. .~ ~ ,~ To be f~lled out b contractor-decontamlnatln~ tank(s).~~ ' .::'~'.Ta~ "Decontai,aiton" CO'nt, a~t°~:~~'~' :"~.UV~ C ~' '- '" ' : ....... a:' ' '""::' ':' "'" " '" ' '" '"' ' -'"':~; .... ' ':'::":'" ' ' "': Phone ....... "* '"~~~ ~. · . -~ , -.. .....~ -.. . ., :~..~ :a~::~,~:~:~::~'t;-~¢::' uth'orized re resentatlve of. contractor certifies b~ st~ln~ below.that. tank(s) have been decont~tnated In accordance with Kern County .~e~l}~a~:.,~.,~G::8,.,::-.:,:. Department requirements..,. .... : .,,... ..' ' - ' ....~ '. :-.,:::~:.:~;~(~:~.~.:: ~t~na ;el,lo; =-~o b, filled out and ,l~ed ~ an authorized representatlv '.-' '' : --ea~e'~ stara o' ~dts osai factory accecttnE ~ank(s)' - · - - ' ....... ~" ~~'~'V' Factllt~ N~e ~~/~ ~~ ~~~' ~ , . : . . : - . - . . ~ ~ _'~. ....... Date Tanks Rec~ved..: :~ '_~~~-~': .... ~"'' , .. ,.....:.._:..:: ' .. :~" ' '.. "· . .... :...-: ":?:~ :>.._.:::::'.. :.'... ' · * * ~ILING INSTRUCTIONS: Fold in half and staple, ... ...... ~:::..: . ::..: : (Form ~I~i~P-160) ~ D~s'm~cr e~c~s