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�sDLToist2, Iq4vsr��t <br />�,SJ[3nn ysst`1 �0 2 1F'L.L 1::�O1J2 str��5 <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />..tfia...r...rl..r♦f•....il.lfrls..rf....sr•f..11..last•it...l.ii.rer.ff.r....r...11r. ►........r..... r....• <br />3ECnON 1 - Public Health Services Tracking Sleet will accompany each tank &Trend with its Site identification number. <br />The Traddug Sheet is 10 be returned 10 Public Health Services within >e Aero of acceptance of the tank by the disposal or <br />rtxyding hdlhy. The rasa bolder Is respomilge for eastirleg that " form d <br />h completed and returne <br />FACII=NAMP- C—AL-U CST' M*t -� NIA2[rr SYTc <br />FACII.Ti'Y ADDRESS• 424 �5 - TEGNET, <br />lova �5 c. NABS S_ uu�T <br />TANK W E29- 'i oo 4�- -013 Tank Description: Tw�yo EA/6 / �op D(4t- 69A5,,o"L 5,�, 6A-4- &Ass <br />550 �1— WAS' O Z.. <br />fttt.l.!•i.ff.tf.if►...f..r.ttt..•flit.!•tl.r..t.••1.t......f.•.!fl..i.i.t.•......t.....!l.......t......l 1. <br />SECTION 2 - To be IIlied out by tankrq�waI contractor. <br />Tank Removal Contractor, JAMES JIM <br />Sox 30331 STOCKTON 952L <br />aty zjp: <br />Phone 2[ 99 943 7793 Date TanbRemcved:-I_�yr s� a rc, {c►q4 <br />SECTION J - To be sued out by wetrador decontaminating maY: <br />Tank Doconuunhadon Contractor, AMFS J. Hk)RI TT7FI I <br />,mom Box 30331 sty, STOCKTON zip: 95213 <br />Phone *: ( 20% 943 7793 <br />Authorized reptlsentative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manger as required by Cal EPA <br />Titles t� (IzRLTv(z <br />.•l.y..•ii.ii li.It�f alt �IiNfftq fH.I rrf•H..gf.1H...a..11.l..tiaa....t.♦1f 1111 Hit HffH..... i... <br />SECT70N A - To be signed and dated by an authOrlud representative of the treatment, storage, or disposal fadIIty <br />accepting tank and/or piping. <br />Facility Name: CAL -COAST TANK <br />Address: 424 J. TEGNER <br />sty: <br />Phone *:f 209 1 668 9378 <br />Date Tank <br />IURLOCK <br />Signature. .nom <br />Zip: 95381 <br />t.ars..lr.a•rel..rriitti.til.....f•i♦.......rttl..ru.ur....s.Ana...l.rl....l•f.r......rfi....i.•s.• <br />ev 23 049 (Revised 7-10-92) Pave Q <br />