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------------------------ ----- ----------- - ------ ---- --- --- -- - -- --------- ----- -------- - ----- - - <br /> 62168?1994 04:14 '209547905: VALLEY ENVIPOH 9ENTAL FwGE 0 <br /> UNDERGROUND STORAGE TAMC DUPOSMON TRACRING, RECORD <br /> uu N•N!N•.upa.Hilt.•N•■••s..H.u•H..u•.gsop•M.••...p...w.1u•.r.••.1ii Y!rlHM r.••.r.p. <br /> SECTION 1 - Public Health Service TmddIg Shoot Will sommpany each tank anted with its site identi9cstion number. <br /> The Tracking Shoot Is to be returned to Public Health Smsmi of acceptance of the tank by the disposal oc_, <br /> +s!tg N ility. the permit holder is responsible for ensuring that this forr. it completed and rttvm,a <br /> FACIIITY NAME: Cal Coast Mfg. <br /> FAC:MM ADDRESS: P.O. Box 1864, Turlock, CA 95381 <br /> TANK M N39 • t O 8 S - 0 h Tank DoMption: ig O c7 a O k i ( a s <br /> .••!r•tlNsr••N•...t.•.1•tttoo*Y.a•.aH•.rq•y...so*....HMNgM MHs7aH p•.s...r.....ur.Y•U <br /> SECTION 2 .To be filled out br uak t�gnlPoronn"xmental Solutions <br /> Task Removal Contr ,=r, V�11 <br /> Address: P.O. Box 48 C9ty. Stockton Zip: 95201 <br /> Phone#- ( 209 1 547-9000 Date TWLkRY <br /> ....................s...1........ ....u•••...•t•••..•...•......................iY a.a••........0......... <br /> SECTION 3 t To be filled out by contractnf 'decontaminating tanY: <br /> Tank Docontamiaation Cbntrattur. Valley Bnvironmental Solutions <br /> Address:, P.O. Box 48 C117 Stockton yP:95201 <br /> Phone N: (?09547-9000 <br /> Authorized representative of oonuaetor artitydng through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA <br /> SigoatW Title: <br /> .UYt.t Rrr♦M HN•r...•N.N••HHHtrr M.IN•...•NY.N•...H..tH.1•r.M.Y ......u..0.......uta..a <br /> SEM- nN A.K'l,>be alghnd and dated by an authorized Yeptasentative of the treatment, storvgc, or disposal facility <br /> a.-!"C.7 <br /> FatilityNam— Cal Coast Mfg. <br /> Address: P.O. Box 1864 Mr. Turlock zi _ 95381 <br /> P. <br /> �— <br /> Phone a* ( 209) 668-9378 <br /> Date Tank Recetved: <br /> i <br /> 9ignatue: iltle ✓�(� '�G1 ��t_ <br /> •a r H.•iiNat.t...q.R.nptNse.tlMtM.......................e .............. . <br /> rR Zd 040 (Rwiad 7.10-92) ry 10 <br />