Laserfiche WebLink
UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />►►t►false»Ns►fwrNN►NNatssN<NwutNN•••ttsw•tt•fN•f•e•►rf♦s•oasugwNff•f N•Ni•J.ffffff Nr<sf ►f <br />SECTION I - Public Health Services Trucking Sheet will accompany each tank alfired with its site Identification number. <br />The Tracking Shea is to be returned to Public Health Services with4t 30 dare of acceptance of the tank by the disposal or <br />recycling f thin, The permit hoidw is responsible for ensuring that this form is completed and returned. <br />FAaLrN NAME CAL -WAST TANK <br />FACHJTYADDR.MS: 424 J. TEGNER ROAD, TURLOCK, UA %381 <br />TANK ID #39 - Tank Description: <br />gittrfNNffr1111tfoftttfNNll tittN•wtfftt Nt•ff **Nff toff Ht•N to•<fN*<<Nf **is* *so** V* so* ****so* <br />SECTION 2 - To be filled out by tank rggmal contractor. <br />Tank Removal Contractor. JAMES J HOBLITZELL <br />AM.. box 30331 Clir STOCKTON Zi 95213 <br />Phone tM: <br />2( 09 9143 7793 Date Tank <br />...........fsaf►t•s•ffft•t•••ftslfooft•f•nisi•tiotsttfslslftff►sofsft•fss•tf ............................... <br />Removed - <br />SECTION 3 - To be fllied out by oontractor -deooetaminating teat': <br />Tank Decontamination Contractor. JAMES J. HOBLITZELL <br />Addrem Box 30331 city STOCKTON tip. 95113 <br />Phone r: ( 20% Y43 /795 <br />Autborized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as required by nal EPA <br />Signature: Tide. <br />off •gffit Hi•ia •ail N• wasofstf ff • woos ••»•»» HtNtt N••t• NtNONNsof off Nff oaf nisi ri oft tt o t4tf off ftN• <br />SECTION 4 - To be signed and dated by an author tawd representative of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />Facility Name CAL -COAST TANK <br />Adder: 424 5. TEGNER <br />City. <br />phone #:( 209 I 668 9376 <br />Date Tank <br />TURLOCK <br />Signature <br />Title <br />tip: <br />y5381 <br />H ttafftto►t Hf NNtf Nww sfNtaaNaNto►•f♦f s<HHftN<N r•if•tN•i<•s•Nf fNtsf Nsi a•t•Nf f NNtf N•N• <br />P1 23 049 (Revised 7-10.92) Pepe (C� <br />