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04/13/1998 12:28 12098325152 WRIGHT ENVIRONMENTAL PAGE 01 <br /> Post-IN Fax Note t aete A&► / <br /> TO <br /> C <br /> fENVIRONMENTAL <br /> CO./DeftPhene0APR 13 1998 Pas. 3 P..e <br /> SAN JOAQUIN COUNTY IR <br /> HEALTH allYMCC61ENTAL a.s.....a.,,,,,,.,•• <br /> PERMIT/SERVfiF6pjtGROt7rw sTORAGZ TM%019PO,=ON TIRAC113 G ARCO'w <br /> rrr...wr..........ar....wrw... rwrw.ww r.wr..�ar.wwrwaa... <br /> SECnON 1 - Public Health Services Estykautuctical 1,199119 Division Tack TrwJdae Shag sitsit ueompaW s"I' taoh aff xcd <br /> with im tito Idcudticaa rnmunber. The Tank TYrcidog Sbea is to be mmrand to Pubiic Heairh Servi*n Eu-Mamanw HaJth <br /> Division within 30 days of accepts, of the toil[by ae disvO611 Of ftcYcLisg The Permit holder is respoaslbLe for <br /> emurng that this form is completed and mnuned. t <br /> PAC L=NAME: t '"i Ski! cT r ! X _ <br /> l� Jf <br /> FACLI.iTY ADDRE55: ?,,a Q -S `LtJ,n l ���r ,o lrt.�p.T,�ci=�c� Q_ � - <br /> TANK IA P9 •! 3°1 9- 1 TANX SIZE / ft&-9d1 PPZVLOUS TANK CONTENTS: � -- Conti s�P. <br /> rrw................rw...«v.++.....«.w��w�w. ..a_ar..rw.r.wr..ww...rwwwo.....+..........+.....• <br /> SECTION 1 - To be ailed gut by huak ctwo,aI Contractor: <br /> Tank Removal Contrxwr . \-ZI �- t <br /> Addrew t12•, .Avki-.__ �! �� � City: 21p: S'3T Ce <br /> Phone M: (0 CA )'6 3-3 • O-1 t:51 Vac Tank Removed: <br /> .................a.wr wrworr.. .rrrw.... ........... <br /> SECTION 3 -To be tWed me by contractor "daeontamLoadixg tank": <br /> Task Decontammuion Coatncwr: . _ ._ <br /> si <br /> Cary: —Zip:_ Cl-�— <br /> PhoneC) 7 4M <br /> A•,yyoriad eptam= to <br /> ve of O==ealitywil disongh nVmmm below fly's she tank bet been dnCoatsmiaaed in m approved <br /> aft®er as re4dsm by Cay IPA. <br /> ada� far-44,.1ttb ritu•.�_11 rvx.,�a`i -�'"�-,a <br /> Name ...wnwe.w....r�.w/,.A+rr�a rrwr.w.rrwwrr�rrr+.rrr..�•• <br /> SECITON 4 • To be signed d dead by m*U*orbw reprsetsotive of tw tttm>soem Mot4n,ar diq°d ZSnI+tY <br /> nowpatrg trait awor piping. <br /> Facility v.an.: ( . ln��•c�- � '�� <br /> Z+P: <br /> AdAddress: <br /> Photro I: t�)_y. Li <br /> .� <br /> Date Taal[ 'red: <br /> Vasa: Title: Stgaaatit <br /> sw .....,,n..«�.....ter..«.�..�...�.....rr....«r.. ...... " <br /> EN Z3 0u6 (RcTimd 9/11,'96) Page :U <br /> 90 J"o -"l_N3*K)dI0M3 iHt I'dM LS T97.£86w1ZT 5T=9L L66 L:BL;ZT <br />