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00 >f �.. NORTH CAL CONSTRUCTION <br /> TANK TRACING CHART <br /> ACILITY NAME: -e IA- r <br /> ACILITY ADDRESS: �U1= 101989 <br /> ANK ID I39- SIZE OF TANK TALHEALTH <br /> ECTION - 2 - to be filled out by tank removal contractor: <br /> ANK REMOVAL CONTRACTOR:. l / � / ((7 /� <br /> DRESS: L-7 /J r j A-n(,) � STATE CA- <br /> ZIP CODE <br /> ELEPHONE: (�20C, DATE TANK REMOVED: <br /> ECTION - 3 - to be filled out by contractor "decontaminating tank": j <br /> ANK DECONTAMINATION CONTRACTOR: 7-e- L�l <br /> DDRESS: �'� CSA--^f 'W A.(, STATE (f ZIP CODE <br /> ELEPHONE: (204 ) -�f(o —.Z 0C, C/ <br /> uthorized representative of contractor certifies by signing below that the tank has been <br /> iecontaminated in an Approved manner as may be regulated by Department of Health Services. <br /> yTITLE <br /> ,ECTION - 4 - to be filled out and signed by an authorized representative of the <br /> .reatment, storage or 'disposal <br /> facility accepting tanks. �r <br /> ACILITY NAME:. �Q�Q <br /> 0DRESS: g�O � /f \CQX STATE e _ZIP CODE <br /> SIZE TANK RECE D: Co O <br /> ' 1 <br /> AUTHORIZED SIGNATURE AND TITLE <br /> I <br /> b <br />