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arrr oa:ab rAd btu DJJ vrba tgjk <br />99 01:24p - r w e HirdsOng 20S 2'a4-2411 P.2 <br />.EIVED <br />JUL 0 7 1999 <br />SAN IOAQU'N CQUNW ruRuc HEALTS SERvicES ENVIRONMENTAL HEALTH <br />UMMGR0 STOAAGN ESAL T TANK DbTus ort TTR� wcsavG uEcmFERMIT / SERVICES <br />..................................................................Y...................... uu...... <br />...'TION) - PSrbILc Heallb Scrviees Pavirawncaral HaltL Division Tank ?sacking $Lea shall meompaoy each n ak affixed with <br />ils si(. idmdficaCon amber. The Tank Tracking Sbeet i5 to be renaaed to pubic Hcslr l SGvit Envieoemmol f&a th Division <br />=ib:e 38 love of arccpraoce of ILe tank by she dis 0 or ma ydins heiliry. The permil UWer is Rsponsible for ew.uring shat <br />dw roan ;e r plesed and mm=d, _ <br />PAcm= NAME: 141 r 'e -a o <br />FACU-rrY ADDRESS: I 13 E, Cl, o 74c-,• Lt/4 r -jr. -ho e j1r- o . <br />TANK ID a39 - 04'Y- _TANK 512£: /.[—T_PREVIOUS TANY. CONrENTSi %r a:r o �! -• �+ <br />... . ................... Y .............. A.....N....I.............. Y........................Y..(I.......rw <br />SECTION 2 - To be -frlcd our by unk removal coorJramor: <br />Tank Removal Cony r:�/ _� CV i �+'! J/ COQ S /. rr /adeo 17 _ <br />Address: 15 0 O A r; e_ 9.13.0 <br />Mona A: 1 go D 2 3 `f — zZ 6 S 0 Due Tank Removal: <br />.......... • ...... ........ u............... ...... w........ .. . .. ..................... <br />SECTION 3 - To be fill d o..t by cvou-mrRr "de®r'm/wmloarLlg tute <br />Tank Decoontimmuwiaa C�onuaa�mr: �/�'JQSiv/Jy� QliGk�rr/// ,//� <br />AddreSl:p�j}�Op/1J�/G�f/�ai�,yC.�J / Cary: !%/�,C�yi%,l/%Z;p: <br />Pbom M ttJ_9% <br />A41,horl2ed rcprescnwrivc of contractor "rufy;ag through sigoamm below char the task has be ticconlaminatcd m m appm,d <br />maaatt as re/qpw�Z� 9.l4is�y�euircdnby Cil EPA. <br />Namc%C. r Title: � of �rP-w U-: Daze <br />SECTION 0 - To be sigsud and damd by au amburued mpresmenve of dw =at==, storage, or dlspma d facii8y <br />arcc�pddn tank and/or piping. <br />Fmdtiry N=.:s <br />EH 23 046 (R..ised 10119r9S) Page 10 <br />