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sssssssss:ass*#mmmmmmssssssssmmsssss:sssssssss:assess:ssssmmsssssmm##ss#*ass**smmsmmssmmsssssssssssssssssss##ssssss# <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 facility. The permit holder is responsible for ensuring that this form is completed and returned. <br />FACIL=NAME: Bldg. 647 - DDRW - Sharpe Depot <br />ftUNI 4rr> <br />Roth Rd. <br />Lathrop <br />sssssssmmssssssssssssssmmmmmmmmsssssmmsmmssssssssmmmmsmmsmmsmm:sssmmssmrssssassssssssssssssssssssmmmmsssssssss:ssssmmssss:ss <br />SECTION 2 - To be filled out by tank removal contractor. <br />Tank Removal Contractor. Oil E n u i n m e n t S e r v i r e <br />Address: P.O. Box 950 City: San Andreas Zip: 95249 <br />Phone #: ( 2 0 9) 754-1808 Date Tank Removed: <br />s:ss.:s:::..ss:s::ass:ss:::ss:ss..ass::.ss.s:s:mms:smmssss:mms::s::mmmm:s.#mmmm::ssmm:mm::mms:::::.sass.:::.:mmsssmmmmsmm <br />SECTION 3 - To be filled out by contractor 'decontaminating ': <br />Tank Decontamination Contractor. Oil Equipment Service <br />Address: P.O. Box 950 City: San Andreas Zip: 95249 <br />Phone #: ( 209) 754-1808 <br />Authorized repr a of contractor certifying—through signature below. that the tank has been decontaminated in an <br />approved m er r by Cal <br />Signature: / 'Hue: President <br />th A. T al L is <br />sssss#s..s.mm:ssssss:sssmmssssassssssssssmmss#smmsssssssmmmmsssss.mm:ss.s.:ssssmmsssssssssssssmmssss.ssmmssssss##smmss <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:Triangle Inc. of Sacramento <br />3525 52nd. Ave. <br />Address: P.O. Box 9795 city: Sacramento Zip: 95823 <br />Phone #:(916 ) 421-1990 <br />Date Tank Rece' — 14 -7R <br />/X 4 <br />Sianatu a Title: f'e <br />ssssssss#mmasasssssssssassssmmssassassssssaess��ssssssssmmammsmmsmmmmmmssmmmmmmsasmmsmmmmmmsss#*#mmsssssmmssssssmmmm.ssssss <br />EH 23 044 (Revised 7-10-42) <br />Page 10 <br />,r <br />