Laserfiche WebLink
UNDERGROUND STORAGE TANS DISPOSITION TRACKING RECORD <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 />FACILITY NAME: Waterloo Food & Pup -1 <br />FACM=ADDRESS: 3032 E. Waterloo Rd. <br />TANK ID #39 - Tank Description: 5000 gallon single wall steel <br />SECTION 2 - To be filled out by tank removal contractor. <br />Tank Removal Contractor. Oil Equipment Service <br />Address: P.O. Box 950 City: San Andreas Zip: 95249 <br />Phone #: 209) 754-1808 Date Tank Removed: 2/16/99 <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor. Oil Equipment Service <br />Address: P.O. Box 950 City: San Andreas Zip: 95249 <br />Phone #: i 209) 754-1808 <br />Authorized =reprof contractor certifying through signature below.that the tank has been decontaminated in an <br />approveded by Cal EPjAr-;7 <br />Title: President <br />'KbTth <br />issssssisssiassss##ssss##sss####ssssssslssssi#issssssls##stsssssisstssst!!#!###s!#ssisssss#sstssssss#!!!!ss <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 />Address: 3525 - 52nd Ave. <br />Phone #: ( 916 421-1990 <br />Date Tank <br />City: Sacramento Zip: 95823 <br />Title: M-51elee <br />iiYiiiiiiissltiii!##1iii#!!ii!!it#iti#iii##!ii#i#!lYis#it!#!!#till#i!!i#ii######lttiii!!iili##!i!##t#t#i <br />EH 23 049 (Revised 7-10-92) Pape 10 <br />