Laserfiche WebLink
WEST COAST EQUIP SALES 1 209 668 9382 P. 05 <br /> r <br /> SAN JOAQUW COUNTY PUBLIC MALTS SERyICE5 <br /> Uteri RGAOVM STORAGZ WM OMPOSM014 TRACX q(; RECORI) <br /> vw.�JN..a♦ff f III./syf�rw+1YM4�f�,Yk����RM7L1wM+N*�r�llMa sr.iN���f�tWYiA�';�N1��Y�*r1»W�r�./MIW�W+M�+wYfwr W MMY4FYY1M1r1l.hv MN w my.�N. <br /> SECTION 1 • Pubilc Hcalth Scrvicra Raviro==W HeairD Division Tank TrwAia3 Sheet sbalI sccomgaay aCh Mnk affixed <br /> •Viw iu site identilleadon aumbcr. The Tank Ttaaditg Sheet i8 to be m=%Ad to Public Meuith Servteft EaVIMtua=1 Kfalth <br /> Division rdthftt 30 devs of at=etptwct of sic UAk by she disposal or=yeling faeliry. Thr Pnthsslt bolder ti respotmible. for <br /> tusvmg tbX this fords is QMplcted and returned. <br /> FAC[T.I"lY NAME. �y <br /> Ir ACI I.f'I'Y ADDRESS:_ LA VC <br /> .VJK ID X75 - JfjOg-i,,TANK SIZE: 000 � g�U5 TANx CDNTENTS:tj <br /> _0. <br /> h..n.r•r r�.,.w..r:.r.fr...*N.Iff.f..r Nrf ylNYlM.fwwwr.rf.rMfVar..rrfrrvrliWy.f r.fawf.IrwArfff.prrrgb....Mr.arrrr......,.._..y <br /> SIXTION 2 . To be Red out by tank removal contractor: t <br /> T:4xk Rcmgval Coatrsc;or: \.,,a--c <br /> CIty" ZiP ` � ...�,w <br /> ?)o lie t_ CSS ) -�7 Elate T" Itcmoved: <br /> .�a.•..�r�..rrrw..r.....1.......arwrv.•......Nww.•....r...NMu.....w....*wf.'....rfrr....w.....�.r........k.....r.....,.�: <br /> :,F.C'I'1c7N 3 - To be hiied out by contractor "decontaminating tunic": <br /> Tarin Decontutruaation Con[raC:or'Lv r v ` ` <br /> iiar<SS:� I .` '"��Ss � City: <br /> .,k11r110rixed mprrsentuive of cortw=r =tifyidg through Signature beivw that she tank has been decoo&Wniuud in an spprovacz <br /> cct;utvcr as rrquimd by Cal EPA, <br /> Vy. <br /> =-.:y� i 'i[1C: �raSi�L Jignaturt' Date <br /> .............. <br /> SFC 1�QN 4 - To bo signed tend dautad by art authorized rapresentasivt of tho t=tn=ta uotstge. or disposal fas:lity <br /> xcsrapaug tank andlor piping. <br /> `l- �—• <br /> Name- <br /> : dtlrtsa: ity, M,'V , Zi <br /> Dam Tank Recr.;VCd: <br /> �.tiu:� - C-f/� Ticla: � SigAarure• DZte��� Wiz.,r_....,.� . <br /> .:.,..awrwM.tiw..s..r....wr...r..w.rti:ww....s......�,..w.......�.s..e.�..a.aarVfr.r..�.H...f.�rr..a..ww...aa w»»r.,o m.. <br /> - '�j.�h tkt:t5ed 9,! r 96 Pig: iQ <br />