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• - WFgT COAST EQUIP SALES 1209 668 9382 P- 02 <br /> -- ;•_•,� 1 I .G.I.0 t FRDFt ADvANCED GECV h IRNA 209 167 1 1 1 S <br /> Sa1V.10AQ1JliV COU"S:TY" PUBLIC HEALTH SERVICES <br /> E�1TEtfhY\ILi�'TAj, HFALTH VINISION <br /> i^nFRGKOL.ti71sTORAGETANKDISPOSITIONTRACKI,NG RltCORD <br /> . . . . ..----•..... <br /> .............a................................,.................,..a_,......,......... <br /> 1 - ?hiblie Healta Serviccs Environtnenial Health Division Tank Tracking Sheet shall accompany each tanl. AfCutu <br /> :ice idcni.`tcation narnber. The Tank Tracking She-_t is to be rcmmed to Public Health Services F.nvitotunenud itealih <br /> ..;thin 3(t davx of zucprnct of Nc tack by the disposal ar recycling facility The permit holder is responatii1c lot <br /> . . t5dr this Conn is carnhleted and resumed. <br /> '.: :'�a ��d.VaG:--. UC YlOFii_._� P� � �L="�-�1' �¢E'��.�r//tfr�--_•_- <br /> A:SC lith SS:.._.. L.y� .--S_�C-�Y4_ L/ J✓i°t?�� f s E _y ? �A� <br /> TAN <br /> PREVIOUS TANK CONT&NTS: <br /> . _....._Y.i.0+w. ... ' �Yi t � _ <br /> ..............ww...........•.www...a..a......... N...w.. r....S..{.1a�7wr.1.w... <br /> '"C- 10N <br /> - <br /> 2 . To be filled out by tank removal contractor: <br /> !"moval Contractor:--.J� -..- <br /> v`Is <br /> 1..-- <br /> _. CiN:_�Gf�iA�1_Zio:. '�.:J r-•0-� <br /> yfGo� _ Date Tank Rtmavcd:�_ _ - -- ...-�._.. .......... . <br /> . .-.......ra..usa.......n..*......a.w..*A..zp....awwwT.aM.k..........w.w............n..pwa......... <br /> ,ON 3 - To be filled out by contractor "decontaminating tack": <br /> :-�::. J .:rctamuzaron Cont:aaor:—__,_..�..,..— __.._._._--___--•--- <br /> . :.•r.n.rd retimsentarive of contractor ceitifying through signature below tial tfie tank bas Dein decontanucated in an approN'cl; <br /> Date <br /> -.........r...ru.w...w...owawaw..u.a.w.wa...v....w...r.......aw.,...w.a.wwb..........rww.w>v........ <br /> . <br /> > t`1710N 3 - To be signed and dated by an authotited representative of the treatment,storage, or disposal facuirf <br /> act:sv;u LwA And/or ppip_urg` <br /> City: 1U1Z(.CC4L _Zip: I)'-5) gtV_ <br /> - <br /> Tale:_�� Si <br /> .___....v......ff..._........r..................................—......r..rw.............................. <br /> . . .. '•,`.r.-s.d 1•'1 YOl p3gt t0 <br />