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UNDERGROUND STORAGE TANK DISPOSTITON TRACIQNG RECORD <br />I,.t,•t.•ttt6.0006t00100tt,t•t,•,0.00000t$a,a....•,a.•0.••If•••tf,.f1•atttf•.r••at0. 0000a00..00,i1t0.0.0.0• <br />3wnON I - Public Health Smites Tracking Sbm will accompany, each tank &M=d with Its die ldnntif atioa number. <br />The Tracking Sheet is to be returned to Public Health Services MthL 30 fora of acceptance of the tank by the disposal or <br />""clin'll bdiity. The remit boidv k nespousible br easutlag that tisk form Is completed and returned. <br />FACILITY NAMEr- CAL-UOAST TANK <br />FA(uJTYADDRESS: 424 J. TEGNER ROAD, TURLOCK, LA 95381 <br />TANK ID #39 - I QJ q —0 _Zi Tank Dascripctoa I � <br />,a,•t,•rr•ta•0000000,tat,,.,..a..,u...,•a••a..f•.•.a••••..•,••..••,r•...„.a,•..,aiq.,,,.,,•.ar►,,...rr.. <br />SECTION 2 - To be Mled out by ta I contractor. <br />*ar-k Removal Contract:,:. 9,,ES 1,T -7 -IT ZELL <br />Addra w Box 30331 City: Zip:STOCKTON 952 <br />Pbone2( 09 y43 7793 Date Tank Removed 14 `) 4 <br />SECTION 3 - To be Mad out by contrackw -deamb einaUyg Ink-.. <br />Tank Decontamination Cbntredor: .IAMFS .I. Hnpj 7T7FI I <br />Am .. Box 30331 STOCKTON zJp 95113 <br />Phone #; 209, 943 1795 <br />Autborized representative of contractor omlfying throaghh slgmture below that the tank has been decontaminated in an <br />approved manner as required by nal EPA <br />Slgtatnlfi - �O 75tIe: (_.avt to ar-Cn <br />i <br />........•tls•t aar� ••.•t,.stt► 0000••.•• • .•a.••s•••••••••.r•••as.••••raatt•a•aa••r••ts•aa•••••sa•• <br />SECTION ! - To be signed and dated by an Authorized tepsrseutathe of the treatment, storage, or disposal facility <br />accepting tank and/or Piping. <br />Facility Names CAL -COAST TANK <br />Addrew: 424 5. TEGNER Mr„ TURLOCK up: yM <br />Phone t: (LYS 668 9378 <br />Date bank Received: <br />•aa••.•r•ttata�a»saga•art»,t u•••f,•0aaaa•••0„prq•.•.••••0.0r,.•.••••f a•,t.•grsr,•0sat••••s••..•• <br />n Z3 049 (devised 7-10.M Pow /7- <br />