Laserfiche WebLink
MU'J. J1. 1J•J it l:hl <br />JOAQtM4 COUNTY MME IC EMAL VICES <br />ENVIRON ENTAL HMTH DIVISION <br />UNDERGROUND STORAGE TAN% DISPOSITION TRACWG RECORD <br />iswrRarrrvwrr*artaaiiKr+rwswMwwr�rWM4WM�wWiw+swa•ss i.«r#aww�sassr#swsrssissafs�w*wawrfwWa*�irwt*sfw#fww*wra <br />SECTION 1 - Public Health Setvicss Eavironme w Health Division Tank Trusting Sheet shall accompany each tank alined <br />with its site identihcationnumbet. The Task Tracking Sheet is :o be renuned to Public Health Services Eavimameatal Health <br />Division within 30 j%ys of acceptance of the task by the disposal or recycling facility. The permit holder is responsible for <br />casuriug that this form is completed and mmmed. <br />FACTL=NAME; CHEVRON SERUICE STATION <br />FACILITY ADDRESS: 'S01 W. KETTLEMAN LANE, LOO: <br />TANK In #39 - 2111 TANK SIZE: 10,000 PREVIOUS TAMK CONTENTS: REG CAS <br />i.'rr.. r.. tr O W06*0*r�aalaw r rrrrarrrr r%wWrw*******r�YMaa.�rrra,�rrrsasaa *aaaaaaar <br />SECTION 2 - To be filled out by tank removal conn-wor: <br />'rankResuovalCantraetor: mUSC0 EXCAVATORS, INC. <br />Address: <br />2155 J%A PALCE C;ty; SANTA ROSA dip; 95401 <br />Phone a:=_-_) 579-0250 Oise Tank, R=Qvcd; <br />it+ar■rraywarrbY„fr,,wwawraa�Awwa�rriarMMwwoaraiirrirwa■aaaarrarra�aarrrrywrawwle"'WW WW"*Mwaaawrwaaa"Vo iriy,q <br />SECTION 3 - To be filled out by cautraetor "daonumiasdug task": <br />Taub Dewatami;13doa Coatrartor: E C I E R I C K 5 o N <br />Address: 255 PARR SLVO- City: RICHMOND Zip:. 94A01 <br />Ph= a: ( 510 ) 973-7462 <br />Authotaud mpreseatadre of coal =Gr =tfying tbmug i sip== below that the teak hes beta dezontam•i=d in an approved <br />M=ner as required by Cal EPA. &� -7//&44 ,,,� <br />Name: BRYAN H. MUSCO Tide PRESIDENT Sigaat Dazs <br />i##sa cow w Mr cow ri r#sr*as*rr Mw#* ## a»r f,aa �, W � rWay.a soca ra r a r r �Y�,###Maifii#wwsw::ia+rikr#sa�,w W a �Y riurr,Y r wM7r #T�rr rr �M�M a r <br />SECTION 4 - To be signed and dated by as authorized represeataUve of the rreaammt, storage. or disposal facility <br />acccptinp tank and/or piping, <br />>?uilityName: ECI E�YCKSON <br />255 PARR BLV•0. City: RICHMONO Zip; 96001 <br />Addr=s; <br />970-7662 <br />Due 'tank Received: I j A.4,TJ - <br />Nzmc. 04V f Q 51TO <br />a r.�YwnMwwr�r.wwN+s's+wwra+r*wrws•*r#wrrrsrRwars�IwWWWs:aasss#afW+k4�}*as#WWwsswi,u�Yrwa+rarwrrsr <br />arrarr*r+rvr+YW*i as , <br />FSI Z ddb (PAvbtd 9/11/96] <br />Page 10 <br />-ah1I—SLiOltJAli3X3 ❑5snw t0: SS NOW $6—S£-:66 <br />