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WEST COAST EQUIP SALES 1 209 668 9382 P. 06 <br /> SAN JOAQV1N COCM-f rUBLIC EVALTU SERYiCLS <br /> EqM0NM39gTAL BULL= OrMON <br /> �.., UNDERGROUNID MRAGE TANK DW09=K TRACMNG RECORD <br /> w�wr:W�•�r,rw rwfKrssw.srrrwrssrM*iWf��a sasWArrw�1#R <br /> xDivision Tank Tt�cciat rShv%S1� aCCdtdpsny e6eb tank afflxef rn�M <br /> SE�`TfUN 1 • F'ub&Health Services EnvlroYmamtaf 5hoct is W be rcrurned to Ftzbllc Health Servt�es nvuo er}c <br /> tank by a1 la�ith <br /> with itS site idcuci cation number. The Tank Tflby it bolder is res ovsiblc for <br /> s�tvisit70 th da of 1.ceptsnrc of the ttte disFoeal or recxGiixtg WIRY- The prttt4 p <br /> t:�surini; <br /> that this fords IS completed and rcttlrtted. <br /> Ft\CILITY NAME: & .�^ <br /> F,sC11,ITY ADOR.ESS 1-1 Ja <br /> 117 X31 • f ._TA.NK SIZE: Oc7 pnVIOUS TAMC CONTENTS:- -- <br /> r. x <br /> w rM1R4F����awww{r1.r00"w0r.A1,r#rray irrYfYy#y1rn�...�,r* +.wrr.#rr�w rs##wsrw�wr wrryar�rrrrrwxMw�.Ar�wrwr.w�.�*MwrMr.•rr <br /> , 'CT°jpN 2 -To be filled out by tank remoV21 contractor: <br /> }nk Removal Cantrnetet: <br /> City: zip, <br /> i�itS;BSS:� l0 I <br /> � )- _ Dace Tusk Removed:Q 1�- - <br /> :'"bon, � {,� a <br /> rrrwr.rrrw+�rr..ltWr..wr�.wrwr..arUW Mw.ws•rlrrriM.••wwwt rr..........arrrsr�wa+Ma*�xw.rw. <br /> 3 - To be ruled out by contractor "d+econtarttinAting tank": <br /> �i ask Dccontattunad0f' Contractor: 1p t. <br /> \n.. <br /> C— l city. k zip;— — <br /> :address: ..,.,, <br /> Phone <br /> ."crtsoctxed representative of contractor certifying throuat sipatwe befo,& that the tank bat bees decontaminated ip snap U <br /> ulariuer as required by Cil F-PA. <br /> Tltie• ` <br /> gigrt3cutt• azta_,.w.r�..; . . . ._ <br /> '4=e <br /> w# #lir�YYrw#ir rrsaMYAYrMr1nwr..r.ar Nwwrw� - <br /> ai..rr arw Mwwrrrwr.ra�r�rW�.srrarrr##F•�Ar#rka#rrwi►#M..�i�frA■yi#rairalyl�►r#�FM1 C. OY diSpUSdi taCilsty <br /> SE MON A - To be signed and dated by ase.represeztWtive ¢f the tI*attz+erlt, stotag <br /> accepting tank andloc piping. <br /> r <br /> St City:�Cs.x�Cyct4 _Zip; <br /> r -, -- <br /> i7atc Tarilc Received; L6 r--�•-- ��--� �� .. _.. , <br /> Data <br /> err.*a�r.NwrrgM s,♦wrryw..w+rrrw+.tr#r#wiNwM#*a�.«rr.r�.rir.M.fRw.r,ww�aiw.w#M•Mr+Y.wr.r,#rrr.n#.r Kw.a..r arv....-.T...,,,.-r <br /> H, 23 046 (Revised 9111196) Page LO <br /> �.-�i r,a'„ ffn'-�T^t!f�i 1Hr�T�{-,1 z•5L57�85�+r I 95=r l ,, , <br />