Laserfiche WebLink
10 <br /> Now <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ssss;;s;;;itss;sss;;ssistssttts;sst;tsstt##t!•t;•tssttttttt#tttststtttst#tttiitttt;ttt;#s;tslssr;s;t;rttttt <br /> SECTION I - 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 facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACIL=NAME: PIEDMONT LIBER & MILL CO.,INC. <br /> FACILITY ADDRESS: 7777 WEST ELEVENTH STREET, TRACY, CALIFORNIA 95376 <br /> TANK ID #39 - Tank Description: 350 GA I A Ml GASCI TWE <br /> SECTION 2 - To be filled out by tank removal contractor. <br /> Tank Removal Contractor.--rJiWIES WOR] i TZELL <br /> Address: BOX 30331 City: S TOCKTON zip: 95213 <br /> Phone #: ( 209 ) 943 7793 Date Tank Removed: <br /> SECTION 3 -To be filled out by contractor'decontaminating tank': <br /> Tank Decontamination Contractor. SAME AS SECTION 2 ABOVE <br /> Address: City: Zip: <br /> Phone #: ( <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: b Title: <br /> sis#iii!#!i!i#itt#lislltii##tlliti!!#ti##;liililslililti#ssssir#tit#lasili#i;l»s;ss»ilii!#ilii#i#lsl»#!illi <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: CAL COAST TANK MFG. <br /> Address: 424 S. TEGNER ROAD City: TURLOCK Zip: 95381 <br /> Phone #: ( 209 ) 668 9378 <br /> Date Tank Received: <br /> Signature: Title: <br /> EH 23 049 (Revised 7-10-92) Page FOURTEEN <br />