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2-13-1996 1:40Fq-1 FROM FIU NER CDNST INC 916 372 6984 <br />� <br />P_ 4 <br />RA#.A#$#*A.a****-•RRAAa..A#A MM.tl #R***a.#*##Q».R.*#N.ffi#* k#�1»»#S kt l tYR####w.lk#6$Ay=IkR R#! !�M#.Y*R#Sk7NeRiffiffi kA li$#R# <br />SEC11{}N 7C - public Health Services 'Tracking Street w%U aecompenyh sank affixed with its site identification number. <br />The Tracking Sheet is to be returned to Public Healrxt Services !! jt of aseeptarrce of the tank t'3` the disposal or <br />recycling fac!lfity. Tjke -t holder is t`b!e of ensuring that this form Coutpleted and returx,ed. <br />FACILMY NAME:. <br />• tea• <br />M <br />2- 3(c N, <br />Z.-0 <br />SECTION ' - To be filled out by tank removal coutractto�rf`�� <br />Tank Removal Contractor: <br />Address:} b City: �- Zip: <br />Phone #-( •� - f S Date Tank Removed: <br />$AAwawAAAA.w##AA.p N[.##AAB.-*#..m.»ars#*�►#..#$###arw $ata*#-A»###+FAm RrF rF$#Y.'.##A�KRw rwi+s A•prwm wwss R*.wx**AR waR$*A. w.'� <br />SEC'1YON 3 - To be fMed out by «sn "deconUnlinUting tank": <br />j:;s r ,,,W <br />n <br />Authorized representative of contractor certsiying thWUgh 5igrtature belowdrat the rank bas been decontaminated in an <br />approved manner as required W Cal EPA <br />Title: <br />Signature: <br />R.=....#YY,c.R#.,»»**$*0r*.#$•ac**##YM»#RRR.**IR# 1RRR #p1.#SA#Yx$ <br />SECTY414' 4 - To be Signed and dated by an aud='Mdrep <br />of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />f�:PlrrCAA l CSD <br />racusLy �.asuc: ,- - - <br />s"r t Cty: Md d Zip: qy o _ ____ <br />Address' rr - fA_ C I <br />T <br />Phone ##: <br />Dare Tank Rea:r ed: <br />Title: <br />Signature: <br />R#y,A.###.###AAs.AB**#AR##A*A B.##.»#,s##A#AA#*#MA-ARB**rR..KR$Aflt.A.#**••$#?#*Jt]E.##rtR.atAR.1R$E#1R»wA*.*A�'RA�Y *aR. <br />EH 23 049 CRevised 7-10-421 <br />Page 10 <br />