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v <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> wssstssstttrssuRrsrtsssssstwrutsswastatep»tRarsaasuaswsasssatatsssaRsssttawsastwatrtsaasstspsaiaiaas <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affnted 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 /> A'atility. the permit hnldrr i, responsible for ensuring that Shi form,L completed and 7eturuv... <br /> rAC MYNAME: Cal Coast Mfg. <br /> FACIIdTYADDRESS: P.O, Box 1864 , Turlock, CA 95381 <br /> TANK ID #39 -_L[)) Tank Description: 500 Gallon Waste Oil <br /> rttssstwst»ttaasssattastttRawutttaaiiaatasaatwaRtsssssstrtrraRaYtataatttwwurrawttRtarriaiiaataatasttirts <br /> SECTION 2 - To be filled out by tapir removal pontractor. <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 /> ttatttsstaawtattatttaRYtraaraitttaaisiiiiaatitwprtattsYttiRasrRRriassarttttrRawrttRrtRRtsstuittiiiiittii <br /> SECTION 3 - To be filled out by contractor 'decontaminating tank•: <br /> Tank Decontamination Contractor. Valley Environmental Solutions <br /> AddressP.O. Box 48 City: Stockton ZIP-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 /> itYittYYitiitiiitiittiitiiiittttttiti Yiif titttiRiititiiitYttittRiiaitittti RittiliYri Yiiitiititiiiti tittitY♦ <br /> SE MON 4 , T,) be Signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> Facility Name: . Cal Coast Mf-, <br /> Address: P.O. Box 1864 Car. Turlock Zip:• 95381 <br /> Phone * ( 209 1 668-9378 <br /> Date Tank R=rved• <br /> Signature: Titlec <br /> ttitttiwRttiatttttPaftaOttrtaatOOtaAttRtiiYliilIIfRtttwatitiiRtwtitYfwtttRiw9tttiti0it►rtRiilitROatwattYi <br /> ER 23 049 (Revised 7-10-92) Page 10 <br />