REMOVAL_1995 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD ••r•r•♦ra•••♦•••••••rrp••♦••••••••••••ru••••r••••••s••••••r••••♦r••••rr•••raa••rr•rp••r••r••••rr•r••••r• SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. FACILITYNAME: Farmington Fire Dent FACILITY ADDRESS: 25474 E. Hwy. 4, Farmington, CA 95230 TANK ID #39- o�J I �o ' bt�Tank Description: $50 gallon gasoline tank •••.•d••a•r•r•r•rraas••rrrrr••sa•r•••••••rr••r•••••••••rr•••••••r••••••♦u♦••ru••ur•aa••r•r•r••••••rra•• SECTION 2 - To be filled out by tank removal contractor: Tank Removal Contractor. Paydirt Excavating Co. Inc Address: 269 Oregon St. City- Ripon Zip: 95366 Phone #: ( 7(19 ) 999-2347 Date Tank Removed: ..r•••..•.rr..r•.•r.••....•.••r.r.•.••....•..rrrr....r•.•.••.r.rrr..rr.rr.•.•r.•.r...rr.•r.•••••.•rr•r•r•.. SECTION 3 - To be filled out by contractor "decontaminating tank": Tank Decontamination Contractor: Payidrt Excavating Co. Inc. Address: 269 ORegon St. City: Ripon Zip: 95366 Phone #: ( n99 199-2-34; Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA. Signature: Title: ......•rrr.r.r.....•.•.rr•................•................•..••rr.........•..r•rrr••rrr•rrrra••r•rr••••u• SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility accepting tank and/or piping. Facility Name: Cal Coast Mfg. Address* P.O. Box 1864 City:Turlock Zip: 95361 Phone #: ( 209 )_ 668-9278 Date Tank Received: Signature: Title: ER 23 049 . (Revised 7-10-92) Page 10