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A 1'j T_ COAST EQUIP SALES 1 i2- - 668 • 352 P. 02 <br /> 1 $ <br /> . � t <br /> "j)nn0t70UNu STORAGE TANK 13181`05rTll)N T'rcAt:l{]Na RECORD <br /> r •rrl6666666666►#►rrer6►0000644+►►#♦0►466666666►6101#►r+6l0++0+rrr00errlrRr►ii#44►16r0►►rr►ir►►6r►l4iilRrr►� <br /> glrc;�'1C1N I • <br /> Public Health Servicca Traeking ShOcl will amompany CACTI took aMxtd with Its $ht 140miflcat'1011 numbot, <br /> ckln Wei is It) be rclurned to 1Publlc health Scrvicca �ritl40 �1 d�Y�Of socept"Q0 "I 'he lir nk i y 1110¢IrpO+sl of ' <br /> 'Ciro I rA S <br /> tciycling tacUlly. T$.5 pbr�pal! I7olde�r Ut responslblo for enllalrint th*l 1h11 f4ttN1 �t vorn�lolCd>�ad <br /> per., <br /> FAC1I.11'Y NAMiL4 <br /> FACILITY A1)pitM, <br /> 'rank ptccri,pllagt�� 4 '� •y' <br /> TANK ID #39 - 1� <br /> '.v <br /> ►4rlRRlRri/►Iir4►64141►►rRRr6i4R►i!l►►►►riRi►Irrrrrrl►46R6rrsri►r►4rr66Ri4l►H i#+R►�►�iri►►►►iRtr{4►R0►►#ri, '� <br /> SILCTION - 'I`o bo filled out by tank to a r) ooniractor; <br /> 'yank Ram4V911 C�niraclat' <br /> Address; <br /> City:. 'vp. � <br /> i Dole TO!( Rasmovecl• <br /> phony <br /> ►►rl#406666#4rRitlRrr►rrr6rr•rrrr►rrrrrrrrrrrl4rrrr►rrr►rrrrlrrr••.r!►rrrRRrrR N 0►irrRN ii•►►i�►t►rN 4►►►1 <br /> BF-CTION 3 -To be titled out by contractor "alfiDonta ling I• 't , <br /> •l'ettk )(7calltteru�tlaliop C�tsttacto • <br /> V. <br /> l Addrt;stPhone op, <br /> R <br /> Autl)orizeQ ropreaentativo of rpr►tractar M111 rind through slgnelut,b below that the lank has beat Ytocant*m1Q%W to ad " <br /> opprovccl manner as rcqul(ul by Ca! BPA. <br /> •�e <br /> Slgnaturo; � • i <br /> r6rr460r60R►+'►irs66irrR#rrr!4040/!r!r►i#i!r#/ii#!*644466##1ilrr4rrrrr/14f►itRrii4lir4Ririi4l�►f►l09096i11.*I <br /> t1FCCl'ION • �o l slgnuf and datcd by an authorlted r,tp)osantalira of fttrcalment, storage, or dlspow 1kcwty <br /> oempllall !sok andlot pipint. �! <br /> Faclllly Mamo:.., <br /> Adclreu; _ City: Ipr <br /> C <br /> I)mto Uok Re"Ivcd; <br /> 'Slgnsturc;,�- <br /> 6r.6r6.r••rr6rr�rMrrr►•rrrr0rr6r►0►#rrrlri�t�{tl4rrrrtr►rrrir►rMrrr•6666#r1►rr6►r0iiii4rRr#4ii1R4t#4661040'. <br /> Pass 139 <br /> �H 2Y 049 tltivlR6�d t•t0•Vz) j�, <br /> P ? <br /> SIL <br /> • a <br /> "rY <br /> si <br />