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V 0 r <br /> UNDERGROUND STORAGE TANK DWPOSMON TRACF3NG RECORD <br /> •••.•r••.•,r.a•,•r.•••f•••p•s.••,a.•••u•••••a••.••p.••,•••p•,.r,•u••p.•••q.,•r••••,••••••••,•a„••• <br /> SEMON 1 -Public Health Servide Traddng Sheet wig amonlpaHy each tank &freed With its site identifkatioa atunber. <br /> Tae Ttuddns Sheet k to 6e returned to Public Heatth Services v�tth�! 3p !� of acceptawe of the tank by the disposal or <br /> recycling may The iMok holder is respoas[ble for easarlag that thk form k completed and returned. <br /> FAC HXrY NAME; CAL-WAST TANK <br /> FAaLrrY ADDRESS: 424 5, TEGNER ROAD, TURLOCK, UA %381 n <br /> TANK ID dW- �— D Tank Dosctipoloa: � �J <br /> ....,.r...••s•.f••••,•f•.•.•....,•.......•,.....•...••...,•,,,..,..•,.,,•sf.•••..rs:•.,•.••••.r•r.•••••••►• <br /> SECTION 2 - To be filled out by tankrc'�1 ooatraaor-. <br /> 'lank Removal Contractor. JAMES J. HOBLITZELL <br /> Addr,w Box 30331 air..STOCKTON � 95213 <br /> F <br /> Phone 2( 09 1943 7793 Date Tank Removed: l �I <br /> SECTION J -To be Stied out by contractor'decaatatabuting mak' <br /> Tank Decontamination tbatrac(or—JAMES J. IJOBLITZELL <br /> ,w,,.. Box 30331 ter• STOCKTON 7Jp: 95213 <br /> Peon #: ( 2091 943 /795 <br /> Autboriacd representative of contractor certifying tkmgb signature below that the tank has been dceontaminated in an <br /> approved manner as requited by Cal EPA <br /> •,.u,r.\�_w ..•q••.�r• N•r..0•• •• •b,11v•.rr.••HN.iN•H•HH•1•••f,f <br /> SECTION<- To be signed and dated by an authorized represeatatise or the treatment, storage, or disposal facility <br /> aocepting tank and/or piping. <br /> Facility Name: CAL-COAST TANK <br /> Addrew: 424 5. TEGNER TURLOCK 95381 <br /> Phone #- <br /> 209 ) 937 <br /> Date Tank Race <br /> Siprat>rcC 1-7 v Title r. <br /> f.•..•as• .fu• •s••..p•r.••r.••• •......••.•,r•..•,..•r•••,s.•r••..,u „ <br /> •,•rr••,.••••,• •Hs•••,,..,•• <br /> EY Z! 049 (Revraed 7-ID-92) PNO <br /> �Cj <br />