Laserfiche WebLink
IfU51f�3J Urr1Lt3 rax ����w c�ii -' <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> Rrluix RiH aaattaHYa fYYatHtraiMaaxWMaafii itxr+{sris{aRi>saa>ipsiisriNrrwr W YMriaar■f{ar YYr rip srtw rY+! <br /> SECTION 1 - Public Health SeMcas Trac"Sheet will accompany each tank affixed with its site identification number. <br /> The Tracking Sheet is to be returned to Public Health Sarvlt Vllhln,,22 ds33:of acceptance of the tank by the dispow or <br /> recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACIL=NAMR: PIEDMONT LIMBER S MILL CO.,INC. <br /> FACILITY ADDR�EM. s'7777 WEST ELEVENTH STREET, TRACY, CALIFORNIA 95376 <br /> TANK ID #39 Tank Description: 45A oaf . nN CASE), Mix <br /> asr+r{rYYYr+i/!Y!\{riaaiwr{!s//arMs/taaarM+ltra Raataxr.M>r.Raaaf aari rx Ira ear arra+sa Mtrr RttWYw+rwirarir Mirwi <br /> SECTION 2-To be filled out by tank removal contractor: <br /> Tank Removal Contractor: <br /> Address:BOX 30331 City: S/T�OCKrTON Zip: 95213 <br /> Phone#: ( 209 I 943 7193 Date Tank Rrmoved: <br /> saaa{\siuur{pusaaRYasiksr st»rsaxswris iaarsuxuurauo+Ytt+.urs\airtrisx:rlisa/a rria:\air{rsasaaratr <br /> SECTION 3-To be filled out by contractor"decontaminating tank% <br /> Tank Decontamination Contractor: SPME AS SECTION 2 ABOVE <br /> Address: City: Zip: <br /> Phone #: (_� <br /> AuthoriEed 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:_ L.QVlY1Js'*..�i.(Jl <br /> ltarYrt Nrair rrrrsYaYY w{ir Mtartrfsi tali\iR •»♦i♦r>r>w!r♦Y/aYY wa raif irrkaaltataas ricerrrf xkasrfaa <br /> SECTION 4 -To be signed and dated by on authoriz entative or the treatment,storage,or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: CAL COAST TANK MFG. <br /> Address: 424 S. TEGNER ROAD City: TURLOCK Zip: 65381 <br /> Phone #: (�209 ) 668 9378 <br /> Date Tank R U 9 <br /> Signatur <br /> ♦>i> {>ii>ar >i\a> >b>r YW rr i.M kM\i>'IN r>fi»sat>i>i>a+lrMM tlrfri{t1rY Mr+M{i\i/i/lii r/rrrr\rr>a+ii/ <br /> Ea 23 049 (aevised r-10-92) pry FOURTEEN <br /> r <br />