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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> t♦r#rrtt>t{>«4«#»rtt>♦t4rt»#•t+r++r+>+rr>{{rt++w#rtt4rr+>»+»wtt+»rr»««wt+t#«tato»r+ttti«##rtt»t#+#»»#trt{ttt <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 days of acceptance of the tank by the disposal or <br /> recycling facility. The permit holder is responsible for ensuring that this form is>completed and returned. <br /> FACILITY NAME: PIEDMONT LUMBER 6 MILL CO., INC. <br /> FACILITY ADDRESS: 7777 WEST ELEVENTH STREET, TRACY, CALIFORNIA 95376 <br /> TANK ID #39 Tank Description: 15n rni i nm raSOLLt iF <br /> i»«r>ttltr«rrt+i#tt>itw44rt{tt>{##rt«t>r###«»tYt>#4{>rrlr»rr 4i4rttt#rtt#{}w#t{t4»{t##>rt4rrr+##+«»tt>#ttttrt«»> <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: mMFc unci T 17M 1 <br /> Address: BOX 30331 - City; STOCKTON Zip: 95213 <br /> Phope #: ( 209 ) 943 7793 Date Tank Removed: C LL q� <br /> iiiiii4###t#{tirrt«»i!t{tr!»arrt9r4rrrV{VV+rrirrt#iwf rr r+Wrt4rtfr>#>t«t}##»+rF+4«»trr«r>t>trrrt###t»rrr#»»« <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: SAME AS SECTION 2 ABOVE <br /> Address: City: Zip: <br /> Phone #: (� <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: 21�CL. <br /> #t{ttr{{»4#rtri{rt»rtrtrt»tt{ #rrtrt#rt» •rr>4rt» t+«rtt!{+»rt>#rt#tt+{»#t+•#rt#r!r»rrr l4 rtrtt♦«4»t»tatrt4t» <br /> SECTION 4 - To be signed and dated by an authoriz entative of 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: 85381 <br /> Phone #: ( 209 ) 668 9378 <br /> Date Tank R ed: <br /> Signator . <br /> rtrtrtlrt !rt#tti#W»r»R!t {####rtrtri#+#4ltr!#»+kr+##rrtrt!litiwti4!#r+i{tW#}#!#t>###+{####»t4+rttt#ti+t##tti{>{ <br /> ER 23 069 (Revised 7-10-92) Page <br /> FOURTEEN t t� j <br />