Laserfiche WebLink
UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •ssatrsrsatrsstasssrarisessatssassuarsastrrasasrasssrasssraattrasrasssasaatssprssrasaraastrasssprasuaai <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br /> The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br /> ,`3cili y. -the permit holder is respons,"lle for ensur;ng that Ihis form& compieted and returned. <br /> FACILri"YNAME: Cal Coast Mfg. <br /> FACILITY ADDRESS: P.O. Box 1864 , Turlock, CA 95381 <br /> TANK ID #39 - L� � i -(� _Tank Description: 7000 Gallon Gasoline <br /> ..at,...,..,.aasstsssssas•♦satrs•ass•u•itaststsssrastasssitas••ss•R••rr•Raatsss•asttssilttstas•ssilYit+#. <br /> SECTION 2 - To be filled out by tank removal Sontractor. <br /> Tank Removal Contractor. Valley Environmental Solutions <br /> Address: P.O. Box 48 City. Stockton Zip: 95201 <br /> Phone #: 209 547-9000 <br /> U Date Tank Removed: <br /> astttss•ussrtsslsasraassta•satassaassstss•riaastR♦srstptstsiassststasssstsr•aassitsssusstiassitsattattli <br /> SEC17ON 3 - To be filled out by contractor 'decontaminating tank": <br /> Tank Decontamination Contractor. Valley Environmental Solutions <br /> Address:_ P.O. Box 48 Cid,. Stockton p:95201 <br /> 71 <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 /> ttfitYiYtt Rtitfiiitlttltitlt}}#Yitt#itttt+.?Yi;flit}Ytii!}iitit;iilYtY!}t1tR##ititt#i!i#}itt Yiliiti#t##tif t! <br /> SE MON 4 • '03 be signed and dated by an authorized representative of the treatment, storage, or disposal facilitj <br /> t. c x:_'/;- pipiag <br /> Facility Name: Cal Coast Mf-. <br /> Address: P.O. Box 1864 City, Turlock Zip: 95381 <br /> Phone #: ( 209 1 668-9378 <br /> Date Tanta R,ceived: <br /> Signature: Title: <br /> straaassasssasilasstsasalssrsasastssaasiasstatRtss•asaealYsi!lRasrasstsilssstsarrassssssrsriaaasiassstii <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />