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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •••tette•:rt.lei•rtiatplr•t•attttatttt•asta•u.tat•tt.t.•a•.t.•tetra•srrsrs•riiuttraatu•tat.tt•aattit• <br /> SECTION I -Public Health Services Tracking Sheet will accompany each tank alTimd with Its site identlHation number. <br /> The Trading Sheet is to be returned to public Health Servkes Whbla 30 fans of acceptance of the tank by the disposal or <br /> 7eL7ding facility. The teradt 10 i is responsible for ensurtag that this form Is ompleted and returned. <br /> FACII TY NAME CAL-WAST TANK <br /> FACILTIY ADDRm: 424 J. TEGNER ROAD, TURLOCK, l A %381 <br /> TANK M ,039. 166 —01 Tank Description: ✓ Ct �� <br /> s►t•at•tagNttttat•aqt.a.•••a••ltlu.............aattta•pttt•tt••sett•stitatuttairirtpt•at.tttatstttt• <br /> SECTION 2 - To be filled out by tame reAtoval contractor: <br /> Tank Removal Contractor JAMES J. HOBLITZELL ---------- " <br /> Address fox 30331 STOCKTON 95213 <br /> aq zip <br /> Phone 2! 09 i y43 7793 fate Tank Rernov%xE <br /> .t.a.ttttttt••t••Itt•••••t•♦H•.1•at•t.tta.•tett•tett.•.•attattta•.••t•.•ft•tt..•.tttt..•tt.t•tss.t.tta ants <br /> SWnON 3 -To be Mand out by contractor-decontaminating tatrk' <br /> Tank Dewnmmtwdm Contractor. JAMES J. HOBLITZELL <br /> Add. Box 30331 Cuy- STOCK ON Zap: 95213 <br /> Phone #: (709 (143 /795 <br /> Authorized representative of contractor certifying through signature below that the tank bw been dewntaminated in an <br /> approved manner as required by Cal EPA -{——� <br /> •.t•q.tti M•ii .•tit tt alt•ail Nattq a•!t Nt.tlt•ttt..•M•tq.rtttt ttlttN tttl Ntp!•tlaatttf ansa <br /> SECTION<-To be signed and dated by an aothaimd teresm the of the treatment,storage, or disposal facility <br /> accepting tank andlor piping. <br /> Facility Names CAL-COAST TANK <br /> Address: 424 J. TEGNER TURLOCKZip_ y5381 <br /> Phone #: C 09 , 668 ?5 <br /> Date Tank Razived 7 / <br /> Signature: XA <br /> Titin <br /> / V <br /> ♦t Nal lila tf•1lt si Hdtil•taas.tt H.ltttsttlt Hat•as•.1•a•ass•NNa•arttts Ns•tltlaaN a•rttstt tt.asH <br /> EN a 049 ( rod -10.92) pao Ja <br />