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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> axaa»taafa>a>a>a}:#aa}alifsfsai>aasaaasiai#if;faiiiafl;isfaif»>aa}i#a»»fa#s;f##acts>a>ai»:v>aifxiax>a <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 fatality. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: z'02 FE 4 -%7Z 23/!/ <br /> � r/ <br /> FACIIITYADDRS: 7�7 <br /> FST��c%ticX, <br /> TANK ID #39 - /OZ7 UT J Tank Description: 6-000 ria 1 1 nn ci nnl P Wa 1 1 CtPP1 <br /> sa>f!#i##s#ax#aaa»>a#f#»ii!>i+lxssiaa#faaa;asa}#s>a>a}i»}iris;}!as}iai}if}#>iiilif;a»faasaa»aaafa#aa;laa#x <br /> SECTION 2 - To be filled out by tank removal contractor. <br /> Tank Removal Contractor. Advanced Environmental Services, Inc. <br /> Address: 1419 North Market Blvd. , Suite 5 City. Sacramento Zip: 95834-0457 <br /> Phone #: ( 916 ) 928-8300 Date Tank Removed: <br /> •ax>ti>a>!i##>##a}xa»>sf>f#ara>fs:>#aa}ti>»>ai>ii>faaa>asaaaas>si>fiii>>f»>xfa>###ax»taasfaa}afx»ax:sass»> <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": / <br /> Tank Decontamination Contractor. Advanced_Environmental Services Inc. "/1(gW j 744 4�oz w <br /> Address: 1419 North k Blvd„ Suite 5 City: Sacramento 7 Zip: 95834-0457 <br /> Phone #: ( 916 1 928_8300 <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: <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: 6�,q//C-50O/l/ <br /> Address: 033 �/� Dui 3a) City Zip: <br /> Phone #: ( 5e"0 ) 2,,351 /393 <br /> Date Tank Received: <br /> Signature: Title: <br /> EX 23 049 (Revised 7-10-92) Page 10 <br />