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WEST COAST EQUIP SALES 120Q 660 9382 P. 02 <br /> 03/26/1993 09:e4 ---•-•------------ - <br /> 1.205.T..c5152 WRIGHT ENVIROMd NTAI. <br /> r• fill"".}i. . <br /> SAM sOAQM COUKI'Y FMXJC RSALTH R2VICES <br /> UNDERGROUM STORAGX TANS D7.lPOui1I" ON TAACIQgr_RECORD <br /> •..wwwa...rwrrr....arM..a..lr.aaµ...r f�.ar.aryrY..a�ygrTTMfi►r..'.'.frrriw.rarr•tiw.a.w.lrar.•rrrr..v.r <br /> SECTION 1 - Public Halth Syrian Ear* mapal Health Diridaa Task Traidas Sham AAS=*wP=Y 06Cil W%k MILtcd <br /> with tta$Ica ldeat;5mdannutnbm Tb4 Tack Trackitrg Sheet is to be muiraed to MIM ROM Savim EnvimQA=tal ilaith <br /> Division POWL29 4n of accrpraacs of*A Wilt by the dtapvW or re;rJkg faali T. The pe mic holder is cespowibla for <br /> mturug that OW form is completed ml ammed. <br /> PACE1ITY NAME: LQd \ <br /> PACILITY ADOtI•Q.,S: <br /> c <br /> TANK ID,I39 -71 L9 L 1��TAMC=M 16, cr.t len PREr10US TANK CONTENTS: F� � �a�nti►�� <br /> •.rr.rw►.rrrrar+wN.r..�'..'.i"a'r•.r..arrrrr.Mr"r..rr...ar...w.r.�......r.��...•. <br /> 5ECTIOM 2 - To be Mled out by tank reraovol coatracme: t <br /> Teak Removal CQA"Wr <br /> Chy: zjp;--c <br /> phone a: ('2cr__Y ,,)fs3� o"r 55 <br /> „.-•—^ once Tmtc Removed: J_�1 <br /> w........a u.......".M.r......r .........�..b <br /> SECTION 3 -To be Mlcd out by eoatraetor "deeontatnl—r1ag tads": <br /> Took Dw=ta=&Iioo Coatr=cr: St^+ <br /> Addrts ;14C (` n "_ f rg —z, 3 c h <br /> Auuhorired regtcaedcmve of 'G=d[ytng thr%gh signaturs below that the tmk baa ham d=aX:mMCmd In m 4vroved <br /> mmvfw >s nutted b9 Cat PPA <br /> Namr -TwkQ .It o Tue. l I I C- v si�atuerr. <br /> uarrr.�M.+..r."/r+r+1.w.a�r..wwr.eM+r..✓1MMw�.r�r�.r, r+....w.1..ww.w+.a..arw.«...n <br /> 59CTI0M , - To be signed sad deed by m oadtmfW rvpm=a4Y4 d tbt tram w=Wv4 ar Sisprseal fxility <br /> sacpdag omk a war pip*. ` <br /> rddresa: tis■,1,'(�1>�s...v.�..�-.1�e?1aQ <br /> phom <br /> Date Tack Reaxved: 3' 0 �------ <br /> wa�:�li�o2 S �lfC(/}) TiLLa• C '�yti1t_ Sigaaaite: J acs_._ . .,._� <br /> ur N.r....a..r.....war.r..w.r..+rr.r.Nrr.....w.r rr.wrrrf.w.a...w.r.N.....w.............. <br /> r.r <br /> EH Z3 046 (Rrrised 9/I1M) Pati 10 <br />