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S-04 <br />i?li��ir?t r1 <br />UNDERGROUND STORAGE TANK D{SpOSMON TRACIUNG RECORD �I- <br />IHIt•H„f •••taltlttt tt•q•t!t •aHHH1f 1N••t•tHH•tt •ttf,I1•Hf HIt•t1/H•!!••t..... •keel Mlp Htf •tat• <br />aWnON t - Public Health Services Tracking Sheet will ac ompaay each tank &M=d with Its site identification retunambe <br />71e Trading Sheet is to be returned to Public Health Services XHhta 2 iW of acceptance of the r. <br />Ma by the disposal a <br />7 g 5d1DY• The per” isoidcr k responsible 11x ettstirtag that &k Jbr= IS completed and returned. <br />FAMITY NAME CAL-LOAST TANK <br />FACHJTyADDRESS: 424 J. TEGNER ROAD, TURLOCK, (,A %381 <br />TANK ID 4039 - I U' J I Tank Description <br />.aft•ti,•N Nt Ht•♦11.1,11•, tlHU •tf!•Hliltaf t. ,!l,tat tlttt•t,►f •tltttt.. •....•t:t, t, tlNtl H•ItIHIHH <br />SECTION 2 - To be Mied out by tank ramal contractor: <br />Tank Rearoval Contractor; JAMES J. HOBLITZELL <br />Aad.. box 30331 Qr. STOCKTON 95z <br />Pi>�ne 209 943 7793 <br />L—� Date Tank Removed 1 4- <br />............................ ...................................................... t........................ <br />9ECTION 3 - To be Mkd out by coatractor %ecoauminating tank <br />Tank Doconnwdestto,. Contractor-. JAMES J. HOBLITZELL <br />Add,..: Box 30331 <br />Phone *:i 20% 943 /795 <br />may STOCKTON Zip• 95113 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as required by Cal EPA. <br />Signa__ <br />..........i..�a•.•••t•s•••�ftalttia •tfu•Itf •tta••Ittt•t••t1st►»t•N•ttHattt t•f tf alffat, •astNff <br />SECTION < - To be signed and dated by an aathoAxd rtpresentative of the treatment, storage, or disposal facility <br />accepting tank andfor pips <br />Facility Name: CAL -COAST TANK <br />Add rea: 424 J - TEGNER <br />Qty: <br />Phone s: f 209 j 668 9378 <br />Date Tank <br />TURLOCK <br />Zip: <br />aa1llt••.�..., �.. ••t••INtf ••HHH,t1•�•Ittt1 HHt•,tut,t•fat•,H,tt•titt, cif 1••lHt1NtJN pH,t, N1 <br />EM 23 049 (aevt•ed 7-10.M PW /k, <br />