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4 <br /> UNDERGROIIND STORAGE TANK VISPOSMON TRACKING RECORD <br /> rat..ar,•.t.a..aattr.t..at...t..•.t.••........ .•r.♦••t•.,t.•..,..aa..a..a...����, �1',fi9'f1!,tt!•��.i�ai...t• <br /> M ON 1 . Puhllc Hto be ealth Servings Tracking Sheet WM acrompaay cacti rank sffizEd with in site- i t}�pF�!'t"'Tame«. <br /> 7e�8 �. Theadlag Sim y htUrtled om" is Ce��Health Souring Nkat 30 orm s amcptaaa of the tank by the ftpoW of <br /> P�� br easarfaj that thk form b <br /> completed and rammed <br /> FAMXrY NAME CAL-WAST TANK <br /> FACaJI'ZI 'ADDRESS: 424 TEGNER ROAD, TURLOCK, l A %381 <br /> TANK ID 1x39- -� L 0 -U I:Tank Description. <br /> t1i H...••.H......1.•.•i1t1H1,H1•..........a..1..f Ht.t..ta.1..a..H f.t•.tJ.,Ii1Ht H...J aat.t........ <br /> SEMON 2 - To be fllied out by tank removal contractor: <br /> Tank Removal Contractor JAMES J, HOBLITZELL <br /> Address: `}AX 30331 STOCKTON <br /> 95L <br /> 209) Y+3 7793 ati zip: <br /> Dare Tank Removed: �' `� /+- <br /> •..r.a...,.ar.ta.r.................aa.t,.r.t.r...f.t...a,..t....,...,t...,..tr.t.t....t.r.,...t...t..alrt.• <br /> SECTION 3 -To be filled out by amiractof. <br /> T 'nation ctrbaMr-JAM J HO OK �'r` <br /> int Deco <br /> A,w,, Box 30331 CLI STOCKTON 95213 <br /> Phone f: <br /> c 209, Y43 /795 Y zip: <br /> A,tbotized repraentadn of contractor certifying thruaEb sig atore below that the tank has been <br /> approwcd manner as required by cal EPA. decontaminated in an <br /> tea« C$V�t� <br /> .............aa.a...►ai............all. ........aa..,.t.s*,eb.ta.tat.••tt Ht.H.H. <br /> SECTION 4 - To be signed and dated by an authorized representatia.a...f til*see**** <br /> ive of the treatment stooge, or duasa <br /> pl teclllty <br /> "'Ing tank Roftr p[piitY <br /> Faa11ty Nam, CAL-COAST TANK <br /> Add,,= 424 8. TEGNER Mr. TURLOCK y53$1 <br /> phone #: �> 668 9378 <br /> Date Tank Rax 7' - - <br /> Signature: < <br /> TTtic <br /> ........4. .... .a..................aa <br /> ........................... <br /> ......a..a....................•.,.1t.......rr1.a.H..at.t..t• <br /> EY a 049 (Revised 7-10-M / <br /> aaae <br />