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RAN )OA"N ct)iwI-V pUnuc IIEAUril RERVICks," <br /> ENVIRONIIIKERrAL IIEALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION 11ACK010 RECORD . <br /> /•aau/a aa►♦aarrraa►♦♦ra♦r►••►•♦►♦r•rr►►►a►►♦►►♦♦♦♦♦♦•♦♦rq►♦♦NN♦♦NI11111M1H111f1Hf1111fIfH1111f111 <br /> 4ht:'I it IN 1 . rohllr. Neni11t ,i1etvires Rnvbonmrmnl Ilenlih Division tank tracking Sheet !hall eceempAny each link IMI14 <br /> *1111 ht site Idcnflllr.ndonnumlrer, the IAnk frocking Sheet Is to be reuuned to Ihiblie Ileailh Services RnvlronremiAl ReUIh <br /> Ihlvhlml nitUln Je.filar! of arreptnnre of the tank by lite disposal or recycllne facility. The petailt holder is responsible for <br /> e.1141111114 111nt this form Is completed And tetotned• <br /> i <br /> ('AC11.1IV NAMI!:Linco.ln Unified Maintai.nence Yard 6.P.A. #MM CAL 000049384 <br /> I•A(:I1.1I V ADbkp93: 6749 Harrisburg Place. Stockton. CA 95207 <br /> LANK 11) /lq - 191 —01 'TANK Slit!: 10,000 gallOPPlIVIOUS TANK CON TRN'rS: diesel fuer ' <br /> (rN4rr trtar•►a►a«aa►N►aN•N•►M►N♦«N►►►HI♦N♦H♦♦♦♦►«♦«rrrrrrrrrr«r♦►►►♦♦♦I N♦♦11♦11♦�1fM111ffgfN <br /> 4KC'I ION t - Ib be filled out by lank remora) contractor: <br /> lank Removal Cnohactot: Jlnl 'llwl•pe Ull r luc <br /> - I <br /> Addlens: 35I_N,_Becktnatlid./I'.U. tlux J51 city: Lalli CA !Zip; Ig5g241-0357._ ___ <br /> I'hnne M: ( 204 )_360-G 115 _ Date Tank Removed: <br /> I r.au r.Irr Marrla«•rNH►M«HN•►►«►♦«rr...rrNr.«r«r•r«HHN♦♦*♦♦•1♦11♦♦N�♦♦♦►1♦M♦1♦1411♦11(9111 <br /> 4Kt:'I SON J - To he filled not by contractor "decontnminnilnR tank": <br /> lank hectnnnmhlallon Comtactor. JIM 1'hot•pe 011t lite. S <br /> Adthriv 351 Il. Becitotan Rd./I'.O. Box 351 Chy: Lotllr CA Zlp;95241-0357 <br /> rhnne A ( 209 ) 360-61'15 ---- <br /> Andonizrd irptrsrntatfvr of cnottactm cettirying through signature below that the tank has been decontaminated In An Approved <br /> manner As regolted by CAI I;PA. y <br /> f Inntr �11?R filvOR __1111e: Ll P Slgnsuue 011e 8 f 3 v <br /> 1 4 . 1i, i•#a N+ ♦ ♦♦Itrljtr �� rrCP ar aft �1Utic1cl•♦o••a♦r♦G►oMn Nv♦a •o♦r♦�♦ilAtI ♦1•fe♦fi111►N <br /> e No �'1 n♦1��♦♦g♦♦r♦$tKIuN A - 1'o ha sgcd andl � Anna♦s,►� ire of <br /> Arrepting 1 <br /> i <br /> tank AndMr piping. j <br /> rncllhyNnua: -5chnl.l.zet• Strcl I't•cxhfcl.s � <br /> liancho Cothiovar CA t <br /> Addles —hOW rolsonl fllyd. --- city: ZIPS 95742 <br /> 1'hdne /: ( 916 1 905--411 10 p p <br /> Date, lank Received: _ pl <br /> I <br /> IHin!:._.__.-- .-_-- —_11ife: Signatu bNe ?� L <br /> r N11•Hraa►►a H•carr►►.►«►a►«♦«rw►rrM««r►r►►Mlr•1►N♦♦♦N«H♦♦♦1♦♦♦♦1♦N1HM1111N111/f11MNNffNf . � <br /> f <br /> VII t104(99 (Reviled 9/11/0) rade 10 <br /> ' i <br />