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UNDERGROUND STORAGE TANK DISPOSITION TRACE ING RECORD <br /> aassssiasr#sitirrassisrsissssisri#tiisistassitittiirrsiisrrsssisr#•ir#ssasfriirissrsiiiiipsassrirss•»tisi <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank afrued with its site identification number. <br /> The Tmclring Shut is to be returned to Public Health Services within 30 da m,of acceptance of the tank by the disprsal oc <br /> v,g t-PO ty. 'I he permit holder is responsible for ensnt-iri r.1 a= ihia toTty ki€_ completed and returned. <br /> FACH=NAME: Cal Coast Mfg. <br /> FACILITY ADDRESS: P.O. Box 1864, Turlock, CA 95381 <br /> TANK ID #39 - Tank Description: 8000 Gallon Gasoline <br /> iirtitttitYriiisittifiiiiittiriti• ittfffwifii#ififittftwtifwtttlftt#tfoffftiftttffiwiii#ifftitittiiiYii <br /> SECTION 2 - To be filled out k <br /> llek removal pontractor. <br /> Tank Removal Contractor. ay Environmental Solutions <br /> Address: P.O. Box 48 Cin,. Stockton zip: 95201 <br /> Phone #: ( 209 1 547-9000 Date Tank Removed: <br /> ••ttwswisiws♦fsidrttstiiirrisifusswiiittrfffswwiafsisiiiraafkftsirrt••swwfiisiit»tswwwwwssasstisit»tfr <br /> SECTION 3 - To be filled out by contractor'decontaminating tank•: <br /> Tank DecoaIamination Contractor. Valley Environmental Solutions <br /> Address:_. P.O. Box 48 Cin_ Stockton 7-ip:95201 <br /> Phone #: ( 209 ) 547-9000 <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 /> Signature:_ Title: <br /> t#kii Yttitwaitititkfi#i1iiY#i###iitt#tittittiii###iti Ytii Yttti#ifittk###sttitikfi##itii ttttii#iiitiifttiiii <br /> _71r�j�T ? . ','n tw ttmPtl err# riatrd by an authorized repr-zentat!vr of the treatment, storage, or disposal facility <br /> FipWg <br /> FacilityNamP• Cal Coast mf.-T. <br /> Address:_ P.O_ Box 1864Cin. Turlock Zips 95381 <br /> Phone #: ( 209 ) 668-9378 <br /> Date Tank Received: <br /> Signature: Title: <br /> fiitt##ffYarifittiitffwttiiR#ftiisititsttiiiiiisffiii#RwYiitifwititr#siiiiiti#tit#tlfiiiititiiY##tt#Yiti <br /> ER 23 049 (Revised 7-10-92) Page 10 <br />