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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />arsttasif ittastrisaflftrs»ltatt#itifxtY}xa#♦triiiix!#}iaafirsstt}riaitxxr}f#if#mita}tia#!#rrffaiai!lxftatt <br />SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br />The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br />recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br />FACILITYNAME: SudLt aA\J PR-QPPrAjE- <br />FACILITY <br />ADDRESS: 23 • r) .riC u .n � <br />TANK ID #39 - �/�� Tank Description: 5DO &AZlON GP60LI Iti <br />SECTION 2 - To be tilled out by tank removal contractor: <br />Tank Removal Contractor: ALL EAL)U/ ) cc 1 E7y�'C. 1NC /- <br />Address: -212,111 t1// Of%(,(% lftV6 U AZO -r/Z� S City: Sq U,CFIMC>ti zip: -916-F3 <br />Phone #: (570 ) 820 32 2 '/ Date Tank <br />tiifiiitii!#latiiiitafafiitiitiiiiiiff#atttiiiifffttif ififttii##tititiififlfit#titiiiitiiiiii#liiififflttii <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: (G/C66IU 1A ( - <br />Address: -2-5-5- f 2 /Z ( !/ 0 City: % <br />