COMPLIANCE INFO_FILE 9 - Laserfiche WebLink

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SENT BY:Xerox Telecopier 7021 ; 02-94 ; 9:03AM ; 9163811622;# 7 UNDERGROUND TANK DISPOSITION TRACKING RECORD . SECTION 1 -Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. The Tracking Sheet is to be returned to Public Health Services AWN.�0 dan of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. FACa=NAME: L-awrenceL.iyermare ation l bor�to TNT) FACE=ADDRESS: orral how oad Trgcv CW=iL TANK M #34 - 1 ' Tank Description; 2.�0-Q lion c aci ei o-walled carbon•atcel tank **«***www*«ww«*w****ww«wwwww***wwww*w*«**wwwwwwwwwwwwwwww«w«w****ww***wwww*w«ww*wwww«ww««*ww*wwwww««*www*a SECTION 2-To be filled out by tank removal contractor: Tank Removal Contractor: ARONSON ENGINEERING INCORPORATED Address: 6809 McComber Street City: Sacramento State: Calif Zip: 95828 Phone #: ( 9 6) 3 8 1 —1 6 0 0 Date Tank Removed:_ _ w*«www*w«ww***wwwwwww**ww«w«www***wwwwwww*w**wwwwx.wwwwwww*****wwwwww«««*�kw««w*w«wwww****w*www«w«w*www«wwww SECTION 3-To be filled out by contractor"decontaminating tank": Tank Decontamination Contractor: _- N/A Address: City: State: Zip: Phone Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal/EPA. Signature: - Tide' ***w«*wwwww*****wwwwww*****www«ww*www««ww«***ww***www«wwwww**ww*waw***wwwwwww«««***wwwwwww«*«wwww*w**w«**� SECTION 4-To be signed and dated by an authorized representative of the treatment, storage, or disposal facility accepting tank and/or piping. Facility Name: Address: City: Zip: Phone Data Tank Received: Signature: - Title: *«***#ww««*«ww**ww*ww**«w**ww*www«w*«ww*+Nww««*w***w*wwwwwwww*www««wwwwww****#wwww«ww*wwwww««ww«w***#wwwww4 EH 23 049 (Revised 7/10/92)