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t <br /> -•_ THERE WILL.$E THREE (3) FORMS, ONE FOR !;ACI3 TANK. <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SR!!4tl ^tataRMArlt Rsttt/elrtrtttrttttrr Rrrt ti/+rrlr trN trrrrrrrrrt Rr rrtrrr}rrtrrrrrrdetrica ti nnum e . <br /> FC-MON 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site Identification number. <br /> yy„ta.betetutaed-toapitblle-Health•Servirns-within 30 dens of acceptanceof the tank by the disposal or <br /> ,. <br /> ,F ttte permit holder is responsibie'for ensuring that this form is completed and returned- <br /> CUSTCM RV <br /> 4807 S. AIRPORT WAY, STOCKTON, CA 95206 <br /> FAC IL DRESS: _ - - -- <br /> TA-K 1D #39 - <br /> rank Description: 12,000 cal, <br /> hr vu lafattittt tlltt Nta trtttaltlHRt tJrtlatttotttt•Nat�rrrrrearr t•t rt•••ra rtrs•r trrr r•rrtrr rr•urt rtrr u <br /> n R� To be filled out by tank removal contractor. ` <br /> oval Contractor. WESTERN METER SERVICE, INC. I'I <br /> 2135 TEEPEE DR:e STE. E STOCKTON 945 <br /> - . City: tip: <br /> AO r ess: _ <br /> 203 948-6124 Date Tank Removed:_ L�p. '�g � <br /> P_honc, : <br /> frtpirtrtrintayarvR. retsttt♦tttt+tt errrr ttrturrr•ottttt+t ttonrr Rt trrrr+a rtrtttttta a•raoattt trtt tr t.a rlrrt <br /> filler oiif•W coiifractor'decontaminating tank.: <br /> anon Conttactor. RF;FER: SECTION 7_, ABOVE — <br /> dress. ` City:-----.— Zip: — <br /> j <br /> ut�on�ti reores eata:ive of contractor certifying through signature below that the tank has bcen decontaminates In an f <br /> ,pp caved m=,er as.required by Cal EPA. <br /> R- 1 Title: 5 <br /> 3 .ria - :Sarni♦ttttat+HtllROttItAllrltlHHHttrtJ rltRNlttt U+rttrtr••rH•Ortrlt•rt•trt•ttttt•t t•ttr tttUtt• <br /> I� <br /> To be sighed and dated by an authorized rcpiesentnt!Ye of the treatment, storage, or disposal facility <br /> �iccepdng tank and/or piping. <br /> Fsc t; Name: CAL-COAST_MFG. CO <br /> 95380 <br /> t <br /> :- GTURLOCK ' <br /> =l-92 TA6TdA -R6A5 Ci.-,�t� �r 7� <br /> Adcr ss I > Or t7" Zip: <br /> 209. ) <br /> X 668-9378 y, <br /> Prior >. <br /> Dalc -rank'Received: 31 <br /> ,ig re: <br /> .. . . Sntt9a rsttarattrrtrtt rrtrtttrt rt tr#tt lr trrrr RrrrttOetrnrtar tn.rax•atrrat•rrra.rr•araraa trr••r•trt+ <br /> EX 23 0,9 <Ravl ted 7-10-92) Peat 10 <br /> i <br /> z f 0--e t <br />