COMPLIANCE INFO_1984-1998 - Laserfiche WebLink

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Aloe -40e UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD e♦sisal+f!lel...Y�.4!l:.R..l...a.s......e..a s. e..:........././.../.see..e..,./.f...owe ..!!!l.s.!!®N......0 SECTION I - Public Health Savi= Tracking Sheet will accompany each tank affixed with Its site Identification number. The Tracking Shcet is to be returned to Public Health Services ..fthfn 30 da U of acceptance of the tank by elle d4cal or recycling facility. T3tc permit bOldtr is responsible for ensurtmg that this form is completed and returned. FACILTIY NAME: =,_(A t =) M i N l M A g- e FACILITY ADDRFSS: I �t7 yr6EM eTt= I t: V-4(-0,-) TANK ID039 - �7 - Tank Description: ......./ effiaale!l..a asl.nee.!l..ee...f..eeeeea..s....essee.e...e.ee.e.*eeel.ee.e.ae.eeee. a..e..ee salt e!lt ate SECTION 2 - To be filled out by tank removal Contractor. Tank Removal Con L�kS SA -12., e2,j EkJ-, At. Tt 'tfAddr 4 ` City. 2Sg: Phone #: ( 7e, a'77 —,:B-70 tc Tank Removed: ...........................................................................................teeee.la.e.tisie SECTION 3 - To be dited out by contractor "decontaminating tank': Tank Decontamination Contractor Lao:t" QjVjjc.JAAe -A1-:= 144-1 Address: ya�E (•J is t— %aLL Phone #: r LLL7 --'137� A.ntbori=d representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cat EPA. Signature: Title:. a.g a a. a t a*0 **so s.es..ees.a.telae.aea.lfal..e..s...lsegeee.. ee..e. se..,e.fas.e...ta..ss SECTION 4 - To be signed and dated by an ve of the treatment, storage, or disposal thcdlity accepting tank ami/or piping. Facility Name:La L- -7-46Le.. Address: 3 �- - Citr Zip. e -737e7 -- 5:2,z2L Phone #: Date Tank Reaefved: Signature: Title•. ....e* a s ad.nee.•......le. e.e....ens..ta.e.ee..taes..e.a.eeea.s.s.ee.eee..e a aee.e,.eeaa.a a e.v.e.selee a ee EM 23 049 (Itwia" 7-10-92) P"o 10 'A SOL OLLZ60Z ?3v1S1S3MAJV1ST1v WCe--A W qZ L : 6 966 L -6Z-17