Laserfiche WebLink
02/06/2007 10:25 FAX <br />VALERO ENERGY <br />ENVIRONMENTAL HEAL <br />SAN JOAQUIN C <br />Tulcphonc: (209) 468-3420 Fa) <br />UNDERGROUNDSTOItAGC:TANKDISP08r <br />........,,......................... ........ — ..... ............ <br />. <br />SECI ION I ., SIC pnviromncrtat Health Department's "tank -racking S <br />ide:tTication aurnbw Tho Taut Ticking Sheet is to be temmad 10 the I <br />acccp:unvc at'the f...k b) the depow! Tire penult <br />eculpleecd end rammed <br />E <br />DEPARTMENT <br />NTX <br />9)468-3433 <br />TRACICING RECORD <br />a0 accompany ca cb lud: dllxcd with"its Sim <br />rmental Health Depattncnt wawujobu q! <br />T Is respoas4lc Or ensu:tug that d is-,tbnn <br />i•ACILITYNAM6./�l.l.L.v'7!, ,, <br />FACILITYADDRESS:___i�o/Y'� S+.!.,&0_ d3cB.. CJI qSJk,(s, <br />I'ANK ID.09• C) TANKSIZE: I I'�- PREV(OUS,7(eNKCONTENTS: <br />SECTION2-To bofilledovtbytanis repto.al contractor,•♦'•••............. ........... ..... .. <br />'fark 4:r. norpl Canvecmr._T]vl" <br />Aaartar: p2 -min e: -__LD 1�i y;%: ave riz�Ct u�zlp (� 2 <br />Data Tank Removcd.(D <br />.. .w.w n ... <br />.................................. .......... _........,...........,_...... .. <br />SECTIONA - To be rllicd out by contractor "dm ataminating tank": *) <br />Tack lleeonm.iaatian Comraem _�t < <br />rV �i- IAK LS hyy Cllp 2� <br />Phone 9: <br />Authorized teprtL•anl➢Iiva ofeentroctot cenifv{r.R Ntovah aignaatm belowMOM=that inc tevi(hea Lc tltrontunineted in w approved <br />MOMas taqutrod by Cal EPA, <br />Namc: y}, (QnT�_yyZf2e.t naa: m _SiSrvtt• Udte (Z�fA <br />•a..wwweet.+Twe.•:Mrtui...Y{..w.e}ww.nwa,.; s..+eef.4..w gfr..w1 w.H+a..u.... v.... w,.,y.+.......+u.. <br />SPC77ON4-To be signed and dalcii by an authorized npraseneative a eat, stuce8c, or dtsposal facility <br />acceohnn!i)'tear'kjandlor piping. 1+''{ <br />Faeility NanaQQ: �•L_1� _,J <br />Address: 1 0 /'voiiV(Q.YW.IV city.'1. <br />Phan., d(�t <br />Uam Tania Rcccivcc:�1ty <br />Nanic$ )L�it'Uti Title:jy_j k-& eestq—, i no�ure: ` ir'Dote ( '7 <br />...................................... ........... .....<.......... <br />{-�....................... <br />, ..... <br />Ell 23 046 (Rcvncd U.11;p(5) <br />,f <br />Q006/006 <br />Q006/006 <br />