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S <br /> OCT 161992 <br /> THERE WILL BE THREE (3) FORMS, ONE FOR encu TANK. �NvpERMlfiRVIHEALTH <br /> I)NDERGROUND STORAGE TANK DISPOSPCION TRACKING RECORD <br /> ff <br /> ed <br /> I <br /> e�>saner•NNu•>wtrw•iww•rww•••w•wttwatauwa wt•r�tewtww••t!e•••ars•••••••••wtw•>,a•••••w•r•••s••tu•w a•w•• <br /> th its <br /> Public [Seal h Services Tracking Sheetwill <br /> gany illhineach <br /> 30 daysofnacccptanee of ithe tankse {ti the dispasalr, r <br /> 4ctpoositle (or ensuring that this form is completed and returned <br /> `CUS WTRV <br /> • - 4807 S. AIRPORT WAY, STOCKTON, CA 95206 — <br /> FAC:L DRESS: — <br /> ;" <br /> A.NK - -2--- - lank Description: <br /> 12,000 gal + <br /> I <br /> c,�.a`.e Mt 'A,lt>�ww•Vtt•a Mee•wfw•>•ea>1•••e•et••w•t•��•>>!>elee•helt!•e•w>t>9••>at>•t»MUa••a••H•e c+u <br /> 5t IODI 'ffo,be filled out b�, n <br /> removal contractor <br /> Tart; R^m Contractor.L1�� Ml IER�'S`ERVICE, INC- -- <br /> STOCKTON 95205 <br /> CEEPEE4'DR r•iISTE: E fig'— ---- <br /> Address � '� <br /> 209948-6124 Date Tank Removed:___ . <br /> Pit ❑e -`' l___-.—,. -----" <br /> sea'x>c sr>ae la••a>•••t•>••.•••••••»>sow•••>»••w•M•tw w•s•wtlwe•a•e•••Htawtww•a U•wwwwa•••aJl•sa!•aH•e• <br /> To be filled out by contractor "decontaminating tank": REFER: SECTION 21 ABOVE <br /> Tank fxcortsrcination Contractor: <br /> City: _— --Ztp: <br /> phone <br /> ' - «or�erilfying thFough-signatutc helow that the tank has bxn drenntamtnated In an t <br /> -- - ----- --Title: SALES MGR. ` <br /> a:�lCY1L3e9 a>alivi>•••e 9.O Nwt•w••V t•o•M•••!•••••w>w••♦w••a•♦•+•!N••9•••e>9 N>•••••Y••tatatHw•t••••w••r t <br /> �.._ <br /> ECl'TON -'i o sigue�i and{datq by <br /> an aatborfzed representative of the treatment, storage, of disposal facility <br /> zccepting tank andlor pipin& <br /> Name: CAL-COAST MFG. 'CO <br /> TURLOCK <br /> 95380 <br /> 1124-2--TAGNAR-ROAD �1 ? r S,, City: yp' <br /> L, <br /> ddrt-ss: <br /> ho;:e : ( 209 ) 668-9378 <br /> t <br /> ate Tank Receiv <br /> �. — _Title.• 3:_ <br /> Signz 're <br /> ><•>••!>• <br /> Dora+a•es{ae.a�•tstt4utJw t•.••••w•••ttwtwtw•<•••wu••a+alew•••e••lrt ea>u•!•see»•rw•t>»>••• <br /> Pepe 10 <br /> 'EN23 0.9 �',(pevised 7-10-92) - <br /> ." J' Bill4 <br />