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FROM : Panasonic FAX SYSTEM PFi(]NE ND� : 61� 753 6222 Dea 11 2fdi2 1i:17AM PA I
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<br /> Parcei number. 10-117 23�21�0006 �,, syste�s�t�; �Compqanl p(�oncompliai►l � �
<br /> - fa�av�arm�ed bylh�s t�m1 ,
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<br /> Tpek In�egri�jr and��tety QAmpitanco
<br /> Campilance I'ssu��2 of� �
<br /> Date of abaerva�an: 1Zl07/12 .�, fte�son tor abssiYatkN1: polr�t 9isalo
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<br /> 7his torm e�ires on(lhrou years); ,�,
<br /> aompliance ques�onslctl�r��c(Requ��d) V�r��ca�On Meth�d�;(Opflon�ly
<br /> 1chBcrrrh$�����re b��. .�. •�Checkthe eppropriafsbax)
<br /> Doea the�eyat�m aanRiat ot�seePaye Ai�. ❑Yes 6�No p proyeat tank bottam
<br /> C@B�pOpl,.dryWEU,orleaohl ? •
<br /> Ao any sewaye tsnk(s)tsaK below thnU p Yes �No � ��erved tav qquld leval ,
<br /> des�g,ned opetxii.re�d4pth? .._..._�„ .-........._. �81 �Atntned oonckuction reoords
<br /> ltYas.identiiyv�JJ�.ohsewepe CI h�Can�nademPb'tWmpad�fank
<br /> tunk leak8. .�,,,,,,,... ❑ prpq�t p�t�►de tank 1�r•blaak SdP
<br /> Any'yea"enaHrorina�lom(qs fhAt fhe ays�em f�fn�lfn(/!o pr�taat
<br /> yraund worer: L� Pressure/V�cuum al�oak
<br /> ; 8ee�e pita meepug 700o.a55o may ue canpDart ff atowed d P�her T, �tlll(6 Pumoac!and c�eanad an 1 T�IQ /1�
<br /> in�rdinanoo by iocat perml�n�aulFwri�. T�nk��ond§ames in pood oondf�ion
<br /> "h�stwrdaN proto�ol eklsde.'rirle Net le nof trxt,au�tiyo,i»
<br /> sequentl,�o�der,noor dooslt lnrpeato wA/otr oomWrroUonp
<br /> ero naceasery to mako iMs dslomJapqod.
<br /> $a�Aty GMB4�c
<br /> S� Are�Ay Mxintaenenoe hde qovets damaged,cr�kad,a appeared!o ba�Utictur�lY t�sountl7 �Y68` �T�o
<br /> 2, Wero�U meln4enanos hole oovere r�d in R eso�ed roann�r{e.g.,alt�c,ewa raMncod�� �Yes [J No' �
<br /> 8. Was seoo»dary uooesa re�tratnt preaont(eafotY��,�o»d oovar,oresio4y nolBn�.-IJqhly recor�mandod. [�Yoa �I No
<br /> 4. Wa9 nny othot safalyM�qith batw proaent'I }�YsA' �1 No
<br /> �xplaln:_,—�..».. ..-_ ,.. -- ,- _.. _-- --..-.—t.....� . .
<br /> '$ys�om Is an lmminant(hn�t co publlo heahli ancl eafe;y, �
<br /> Ger�iflca�ion � �
<br /> This t4nm is to be opmpldked�nd ettaohae M th0¢umrnary�qrr1 oI lhe Mlnnesoia QopWwr Conprot Agenayo(MPCA}Cbmpttanoe
<br /> Inepehtlop Form for�stlating 8ubsoH�Iag'i98waqo 7reatmsittSyatatrin,pbse�vetiwis,Intorpratpqons,and conufuslbns mvol bo
<br /> �oompleted by nn tna�n4tar,r�lntatner,a Se►vlca braNidar.�omnleted fam must be eubmrited to the loo�l unitef n0�mmment withitt
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<br /> Pwperqr awaer nen,e{s}: �tde k�s eollons arcalsul ,�,�„�„�._^�,. ��
<br /> f�roportqftddfaao: ;t7a9,�redCh ta�ce Reed.di�vho.�!N 6599,�,,,
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<br /> Pro�edy qMmar's eddtes2 Ndlfteren�; 6�$JaolCeonvfjja�Jtoad,Suftu�20D,Wartrdnster,PA 90879
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<br /> �►�Y --tionnepin...-.�., ,�,_.., Phone� NA �
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<br /> 1 f��y oer111y f/��t l parsoneAy m�te fhe obsorvallnn3,h�ta�retatbng,�►�d c�r��u�ne repatvd on thls lam and tha!fhsy'n� �
<br /> ta�n� MeikTr�bB�van�. — --- - ....., Certtdcanon numbsr; �oa �,�.,,... � `
<br /> •B��slna��llCe�isenameunclnumber, 1'radewe�,�{�17os11nat�:i07,w,,, � _- , ��� �r ;
<br /> . f�emo oi•iooel tmit,of flnvern nh Ci► o Q_I]?.�—�-,.,�,,;:---�:,._-.:;. ' • - ' - �
<br /> $)glfaiar0: �=���C�-r � ` Ueto: ?JaIl12
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