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• �1 r\ <br />so JOAQUIN COWry FL•BL.TC RAL VICES <br />Z. vMOHMrrAL HEALTS DIVISION <br />UNDEAGIt0UND STORAGE TA.NIX DLSPOSI'!'ION TRACKING RECORD <br />■ar71r 11rr�1wrrMwrrr yr�l�rrrirs la#w#rlUrrww wwww lr*M#wisrfa�.#�►w>tr�rwWWrylMw araylr rawaiarawwv*"- r w 0i[wmiw'a'#iaf0!firm <br />SECTION 1 -Public Health Setvitq Enviranmettml Health Divtisim Tank Tracking Sheet shall accompany each tanleaMxed <br />�vitb its site idandfieatiomnumber. The Tuck Tracking Sheet is to be returned to Public Health Services Envtrotsnioatal Health <br />Division witbi 30 of accepra s of the mak by the disposal or recycling facility. The pawmit holder is respausz-b for <br />ensuring that this form is complcud and returned. <br />FACILITY NAME: CHEVRON SERVICE STATION <br />'FACILrN ADDRESS: 301 W. KETTLEMAN LANE, LOOI <br />YANK M #39 - ZE <br />UNKNOWN TA,,�TK SI: 550 poEVI0US 7A.'dK C0N-TENTS: WASTE OYL (CURRENTLY <br />FILLEO WITH GROUT) <br />rrr srrrsa0r»#yiywwwrr#atwraaarrrw•rr»raa�r'rr* W wwwwr •rarr Wvr•rssrsrsswrrrrwY�wrrwwrwwrrawt+ares#+Ilrrw ■allrrAFwar <br />SECTION 2 - To be filled out by tank rauavl contractor <br />Tank Removal Coatraaor. muSCO EXCAVATORS, I' C. <br />Add=- <br />2155 NYLA PLACE City. SANTA ROSA Zip: 95h01 <br />Dass Telt Removed; <br />�.ryrri♦wrrs•wMMMwarw#*rt•�*wwrrs-rwwrarrr+wraaa�s#r,r#W1W>f>•'frrr*ra rrryMrrr*rs.ssasw:wilrsrws WM�Mww*r#r aarrrysaK <br />SECTION 3 - To be Ued out by cantracsor "decontaminating Bair": <br />Toric Deeocmmmination Cona=or. <br />E%Y ERIU?ON <br />z55 PARR BLVQ City: RICHMOND Zip: 9ti901 <br />t•►ddIC33 <br />phone �k: (51�, 570-7452 <br />AuthQrUW Zrprt*mrati re of conrr=or = fying through sig:nat= below thst tba tank has beta deeonmminatcd is m approved <br />aunatr as required by Cal EPA. t -�v 194ko.-M :Ri --)I 11 <br />N=c: <br />BRYAN H. MUSGQ <br />PRESIDENT <br />Duo — `Z <br />r#r Wrr �Iw� f.rr i •s#a s*s.M W#aw ■wsrrrrar+P+�Wa*RWa*wrta �+Y �# rf4f#MRw'faww wy w W r wr ww*�w*Ttw'sa #�7� si aYww• M� �"�+s►aweYwr # w <br />a otInd representative of the, tre$z=t, storage, or disposal f3cili-,Y <br />9ECIYON a - To be sig�tCd and dated by <br />accepting tank and/or piping• <br />ECI ERICKSON <br />Facility Name_ <br />255 PARR BLVD. City: <br />RICHMOND ZIP; s4eo1 <br />,�iidsess: <br />now #: 5( 1 D } 970�7A62 <br />Dace Tank <br />nate• <br />sii i • r i ii M� WAY rrssw iw# rrsa f.W swMswwM+M*a arsrnrW #*� �*# W aaas+�sW f #!��##M tom# M wsn��nrwr+rw*raw* s�arsoY Y rrss W #*t'�F##t <br />in 23 W (Rovfsetl 9/11/96) Page 10 <br />is-9na <br />"Z0' -d �8FZSLSZeL 7hli s2lolUAW0X3 onsnw 0e:•it Now 6S- <br />