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. y. <br /> z `4 ' <br /> SEP 2 1 IM2 <br /> r 9NV►RONUEN l AL r T <br /> ' ERMIT/KlfV1GL"" " <br /> UNDERGROUND STORAGF, TANK DISPOSITION TRACKING RECORD <br /> t9 al YYrs Rfi�t Yy YY OYt PYY♦Ytaltttt YfaPYYYYt Ya ttiaa Yst Yt Yasa Yt oattP eat YYta Yaa tYrr Ytea+YttatPasaa to PYt Yt YYtP+rY <br /> EC1ON I •Pub/c Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br /> ?-be Tracking Sh6et`is to be returned to Public Health Services wtthin 30 djn of acceptance of the tank by the disposal or <br /> 'Czyc3i g facility.'`The permit holder is responsible for ensuring that this form is completed and returned. <br /> FAClUrN NANIr' MARTHA WEEKS -- -- --- — <br /> 3+�m1� PGEASANT"AVE;'LCDI- CA 95240 <br /> i f( fL DRESS: ' <br /> TAttiI -11D #39 .+� Tank Descriptlon; APPROX 500 C,t+LL h UC FUEL /STORAGE TANIL& PIPE <br /> fYYIO! ilaaaB rViil Pt It LYPYtT to to Pt YYa[mrY PtalY 6ta0Ylal Pt YPa Y atPPYYPYtr4rY9RYra tri`Y�a YPYalaYae♦ etYYPx Ya♦ <br /> '.>ECTIvrV 2 -'To be filled out by tank removal contractor: <br /> 'Tank Removal Contractor. WESTERN MEUE'R SERVICE, INC. <br /> Address: 2735 TEEPEE DR, NE City .S'TOCKTON Z p: 95207 <br /> 209 _1_ 948-6124 — Date 'pank Removed:_. <br /> aaY}St Ya tYtARtYaa aLaPYadlaY tatYPPYt>PYOYYa aYYY}tYYaa#laYYa?Yl ataa Ya Ya sYOttYi,t[9U?�!+,mv Yte YYf aaE Y4JY 494[Y[Ytl4 ' <br /> SEC ICN 3 - To be filled out by contractor "decontaminating tank': <br /> Carle Decontamination Contractor: --- ---2EFEP- L-17. - 2 .1?OVE--- -- <br /> Phone* 7.. ) -- -- -- ----- — --- ---- - <br /> fsuthorizcd representative of contractor certifying through signature below that the, tank has bean decontaminated !n an <br /> approved manner as required by Cal EPA. <br /> 'Title: �fu,� , <br /> i�kP�^i'ltktitiktktittkttittttttlttttititttattlittitt ttt YtiHtYtr teat tetcen:+rmrrtPPvx a}aaPete atrm♦of PPYea Yat YYmrYat <br /> kYft� - <br /> ��S`P',CTIOlti 4�-,:.Tobe signer, aad-dated byes nuthorbed rcprY.wentatirr of the treatment, storage, or disposal facilin- <br /> "' ?accepting tack and/or piping. <br /> '"- 'TRIANGLE OF SACRP.MEN1Y) <br /> Yciljt Iti'ame: <br /> 3525 52nd AVE — Ci SAC i/u9ENIu Zip: - 95323 <br /> Address — -- — -- ---- <br /> 916 ) 42:1-1990 �7 — ------ <br /> Date 'rank Receiv 4 J-[ - I t <br /> - — ------ <br /> Signatures �� c Title <br /> "f tta PYtt YttttltP to Oa aaaa9Y9a11t0 aRataaP Otaa Ra aP tYYY YtY04aYP4d M1dltaav4 rUPlata YtY Pear Y9ty vi t'<Oa 4P00YaiY Yat <br /> 'EK 23 044 "(Revised 7-10-92) Rare 10 <br /> ni�9- <br />