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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> itautttittrlistatiiisaistsisttttaatatiarattwiisrtitiitiiiiirsttiirtiiittttittttiiittitttisaattwtsatwstrata <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 lova of acceptance of the tank by the disposal or, <br /> .acilirye "the permit holder is responsi-ble for ensuring that thin forinds completed and x t�xrxee <br /> FACH=NAME: Cal Coast Mfg. <br /> FACILITY ADDRESS: P.O. Box 1864, Turlock, CA 95381 <br /> TANK ID #39 - , �TanDescription- <br /> -3 5000 Gallon Gasoline <br /> istiassswttsrsaaiirtitrattitaisaaiittatitiaatatttgssirrtiisttsttittaugtsrstistassttawstrrsiwtuitwssi!!i <br /> SECTION 2 - To be filled out by tank removal pontractor. <br /> Tank Removal Contractor. Valley Environmental Solutions <br /> Address: P.O. Box 48 CiW. Stockton Zip: 95201 <br /> Phone #: 209 547-9000 <br /> (_� Date Tank Removed: <br /> ittatsttpttttiitaatstaasststsawttYaistttpittiitssttitittssptswspttsstltttiiisti»issttrrtaistltailtaswi <br /> SECTION 3 - To be filled out by contractor 'decontaminating tanks: <br /> Tank Decontamination Contractor. Valley Environmental Solutions <br /> Address:_ P.O. Box 48 Clty Stockton 71p_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: 1Itle- <br /> tlftNtiiYiiliitillRiftliittii!llttttltiHilYittiilYttiittllf RttitatYtlMittltttra#iitiwf iifftiiiifiiiilltii <br /> BECTIr)N 4 • To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> FacilityName: Cal Coast Mf-, . <br /> Address: P.O. Box 1 864 City, Turlock Zip: 95381 <br /> Phone #: ( 209 1 668-9378 <br /> Date Tank R^ceived: <br /> Signature: Title: <br /> atiiiiitRatitwtttwaittitiitiiiitifiitliitwataiittititiOiri4'tiitttrttttittttiiititfttiittttittitititttitw <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />