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(;,! j„ Pp{f2: 34 UNDERGROUND STOkAGE TANK DISPQSMON T1rACK P#; k.KORD }epaJmJi:•+-5<t>�JAAtlymtoo YA♦me}PtPMYttPtmMbRN}Afttt}mn...ot"ttt►}Rttoo tit t.tt lt,a*"o.....JJfit.....to 5-:;:7! N 1 • Public Health SendceS Tracking S,hact will accompany each tank armed with its site Identification number. T'e T*aci:i Shit is to be returned to Public Health Serv(tes r hfet.,MJ&1 g of acceplJnrat of the tank by the disposal or r^ryctlnji fa(:: fty. The permit holder is responsible for ensuring that this form 1a completed and returned. iAt:i+.ftYNAM' : StOeCy;W Metropolitan AlMrt - redenj Amriation AdminietratAon FACi3..Ct y A,)E).R S; A;rport rAdy, & ArCh Read, San. Joaquin C--. Y..00 tort, CA TANk in >I39 - Tank Dascription:_1 g. dlegAi Czar m�J mtmAmJJ:aS.i.m JfHAY}tt•}tPAYAlRtP}tt HYRJPRtttt}}}}}Rtt}tftRtt,gtttPt}}et}IAt,}♦PPt SAimf fmN}tlRRtttt SECTION 2 . To he filled out by tank removal contractor; Tank Rcnlov tl Contr,ctor:—fjlpt��} _ �r rr�ne - r? inn Ton ----- Addreuri:_,. --- 1824 Bidwell Street „City: R��luitt',CA_ Zip:_„9Woo .,. . Phone #: ( _ 916_)527-5014 pate Tank Remof etf:�gr l 15. f 094 _� -� A}JJHIJY li-r:nA NO MtAY4lH Nit♦t Rtt$RRIi Yt RYtRNttYMd}VMA}YtY}HtlttR}Ht}l6 ttttoo oRtf$Ott At f l tlttAthr*% SrCTJON' 3 )n be jilted out by contractor "decontaminating looks: Tank 1Scc.;ir rumination Contractor: ^°' hr r_SX'zlMt t-1,tlq. Tnin', At1clrCsa;r 1820 BIM11 St agt Citr.R )Y=`�Zip:_,9.4.Q'3o._-_._. Phone #t: (•- .418_) 527-5014 Author,;