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WEST COAST EQUIP SALES 1 209 668 91382 <br /> P. es <br /> PRO i AcvANCED `GEOEtivlk t 209 467 i�w'r8 <br /> j:),i IOAQUIr COumry P1i15LIC HEALTH SF H�'!l ES <br /> gv�litOt`, M--TAI. I3EAI.TH Df�-1510N <br /> t tiUFHGROU�Z) STOHaVE TANK DISPOSITION -rRACN'' Hl ( URL <br /> .........................y.......w.....a<ws..w.........F....0........... <br /> earl. 1:f.. ..... <br /> ................. <br /> .+Pt:b:it i;^_afti i. <br /> Services Eavironinental Health Division Tank Ttakingtopii- Sheet shall 111 Services <br /> ay .. f., <br /> is to be returned <br /> t9ctus of acceptance of the tank by the disposal or rtCycl gifaoa>tryC HIIe perinlit hOld.ry t5 !m(fQlltnl,]t <br /> aat this Torn :s corapieted and roturnec. <br /> . • .:.:T'; ti A�IE (�G_n Off}._ �Y�? .'_r�_!.J�)�.14..M���._S ff�/� y/ J� <br /> i c.3y _ per- lTAC7 i SIZE: /�� t7T�_S(_PREVIOUS TANK CONTENTS -lrif S7�!� .<. _ <br /> . ....,........................wa.w.H...}..wY.........V.......f....... .....wau.n... .......u.. <br /> i f•.N 7. - To `A ^filed out byyttank <br /> ,rre/t»noval contractor: <br /> ��� / •/{�/i 7�] v�^y Ciry: •� 7pGy/ sr_i Zio:__ � !�s'... <br /> . .. ... =' i.Z•J`l )_—�77�!`IOO --..— J Date Tank Removed: <br /> .......I...w..................}.w............... ...... ........... .............. _ . <br /> E ;1ciN 3 -To be filled out by contirvictor "decontaminating, tank": <br /> ,kcontam.naaon =catraaor:_—�, -- ._.__—_..—. —•-------•—...- <br /> City --- `-- Z-P .. <br /> representative of coocxtor certifying thtoup signature below that the tank Sas beep decootantinated in at aepr <br /> c: .s mquired by Cal ---?A- <br /> Sit <br /> 1 ��.t_+ tC c� _, l Ft Acle: t7�s0 —Signature: <br /> .........................Y...}.w.....}YY........oYa....w.wwYt4.......Y}.......... <br /> wY.s.u...w.ow......- _. <br /> •r'i:;TON a _To be signed and dated by an authorizcd representative or the treanvent.storage, or disposal ctcWty <br /> zcccr?c'mS uirk md/orr piping. <br /> T;,-' az._ _ city: 000LZip- yrs F <br /> ,� `r' ) ?Per_ --' S 7 <br /> _X Tx;x RtC:ved:— - <br /> c 7hle: SignatutP jL arc_" �t.f <br /> _..................................................s.............Yu............................... <br />