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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />uuura••r••.e•t•s•tttrtursu r•tut•.uutruturrnut. t.••err».•.eutturuuuru,uut,ru•t•.uttt• <br />8EC'TION 1 - Public Hesith Services TYaddng Sheet will n000mpany each tank affEwd with its site idantlficatios number. <br />The Trading Sheet is to be returned to Public Tiesith Services Within 79 dare of acceptance of the tank by the disposal Of <br />raiding htdlHy, no Permit holder is responsible for ewdftng that this b m h completed and returned <br />FACII.TTY NAME: CAL -WAST TANK <br />FACHMADDRESS; 424 J. TEGNER ROAD, TURLOCK, L,A 95381 <br />TANK ID #N . Tank Description: <br />rtlt.rM• r•rrrrta.r.t rtt it tt r•tt• r...tat•t►N.•t•...aL.Htt.H••ttt••..gt. at..• t i t••t too t-t••t*trt.•rIq• <br />SECTION 2 - To be filled out by tont ramal contractor. <br />Tank Removal Contractor. JAMES J f10BLITZELL <br />Addrew- box 30331 ser STOCKTON �� 95213 <br />Phone #-2e. 09 1 y43 7793 DateTankRemoved:- <br />SECTION 3 - To be lined out by contra"-dewetamiosting task': <br />Tank Decontamination Cbntractor: AAMFC .1. HnR1 TT7FI I <br />Add,,.,. Box 30331 air. STOCKTON - zip: 95213 <br />prone fit; f 20% 943 /795 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated In an <br />approved manner its required by Cal EPA <br />Signature. Title: <br />.•u.....•.u.•uuuuuu.uurtit•.•.•••.••uuu•uu.u.u.uurrrrtttur•uttuutuuaurt.•r.gr►• <br />SECTION • - To be signed and dated by an authorized reprraartadve of the treatment, storage, or disposal facility <br />accepting tank aflur piping. <br />Facility Name CAL -COAST TANK <br />Adder; 424 �. TEGNER 6tr. <br />Phone s:f 209 1 668 9378 <br />Date Vent <br />TURLOCK <br />Signature. TItlw <br />Zip: <br />uru,u.aututtuurterr•••era•••trutt•t•rrPur:uu.u.u•••n.•..•uuuuuu•rtuauutuu.•.tr <br />EM 23 049 (Revised 7-10.92) pap /7 <br />