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UNDERGROUND STORAGE TANK DCSPOSTTION TRACKING RECORD <br />.• . •. •... r. r...,. r ♦,. •., • • • • s n r, •. • • •,. .................... • • s • • •. s. s, • •,.,. • . • • ...., . • ... • •... •. s.... <br />911MON I - Pablk Health Sere Tracking Sleet will wmmpany each tank afflmd with its site Identlf ztioa Oambar. <br />Time Trscidng Shea is to be returned to Public Health Services within ]t► ta.. of aooeptance of the tank by the disposal « <br />1e�g �Y• Thepwm& boldo is responslhie for easdHag that this toren Is completed and rammed <br />FACILITY NAME CAL -WAST TANK <br />FACII.TI'YADDRESS: 424 J. TEGNER ROAD, TURLOCK, LA %351 <br />TANK ID OW. _LCO i a _�, Tank <br />........................................................................................................... <br />SWI ION 2 - To be filled out by tank removal contrscor. <br />Tank Removal Contractor: JAMES J. t10BLITZEH <br />Address box 30331 <br />Phone #: f 209 1 Y43 7793 <br />air- - --....... zip: <br />Date Tank Removed: l A- L=V� 7L 9 <br />.....................................................................................................•...., <br />SECTION 3 - To be ffjkd out by oostractor-demataaslnating roto: <br />'fink Deconunrinatioa Contractor .IAMFC I. Hnni IT7Cl <br />Add... Box 30331 <br />Pbone #;( 2091 943 /795 <br />cur. STOCKTON Zip: 95113 <br />Authorized representative of contractor certifying througb Slgaaturo below that the tank bas been decontaminated in an <br />aPProvcd manner as required by Cal EPA <br />.. Oct ...S1L.•f. 0 r.. <br />Tftla �..�.�- <br />,....,..,.rr......................».u.. r..,•.,...,. <br />SECTION • - To be signed and dated by an autbor and reprrseatsthe of the treatment storage or drsposal facility <br />accepting tank anftr piP�i <br />Facility Name CAL -COAST TANK <br />Adder; 424 5. TEGNER Mr. TURLOCK zip -95351 <br />mat #: ( 209 1 /668 9376 <br />Date Tank <br />710-- <br />00 6*0 <br />itle <br />.♦.r..tl..J N..H.-,ptoo ,.K*...., <br />n 23 049 (Revtsed 7-10.92) Pao 45 <br />