Transcription of Closure Application for Aboveground HazMat …
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Closure Application for Aboveground HazMat …
UN-033 05/17/00 Closure Application FOR ABOVEGROUNDHAZARDOUS MATERIALS STORAGE FACILITIESFor Use by Unidocs Member Agencies or where approved by your Local JurisdictionPlease complete and submit this form prior to the Closure of any Aboveground hazardous materials storage system or facility. Based onthe information submitted below, and the complexity of the Closure , a written Closure Plan may be required (see guidelines).1. Facility Information: (Note: Print or type all information.)Facility Name: _____Facility Phone:(_____)_____Site Address: _____City: _____State: ___CA_____ Zip: _____Contact Name: _____Contact Phone:(_____)_____Forwarding Address: _____City: _____State: _____ Zip: _____ Phone No.:(_____)_____Property Owner Name: _____Property Owner Mailing Address: _____ If different from site addressCity: _____State: _____ Zip: _____ Phone No.
UN-033 http://www.unidocs.org Rev. 05/17/00 CLOSURE APPLICATION FOR ABOVEGROUND HAZARDOUS MATERIALS STORAGE FACILITIES For Use by Unidocs Member Agencies or where approved by your Local Jurisdiction
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