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12-16-1997 6:01PM FROM ADVANCED GEOENVIRONM 209 467 1118 P. 3 <br /> S.1N .JOAQUIN COUNTY PUBLIC HEALTH SERVICr'._S <br /> .E;tiVll2QNbfI•;NI'A), FI.FALTN HTVISTON <br /> li\U}.;i:(>LtUTJiti1) ST(lIt:1G1F. TANK DISPOSITION TRACKING REC01(l) <br /> a#FpF.�..-p#:xc}.p#%FWY$+!Y�pv W94�y A#pppV FA Yi:�wvY'i'#w%9Y'bEa'E4wyF%E•.�pTfi$piiY�i1W#%F-�i�i?n?aYW#!I?Mbw'4FFi4W iW.VWi�'i <br /> SE(:'1'ION 1 - Public Heakh services Environmental Hd P.lth Division Tank Trtr.k'tag Sheet S'jall accompany each tank afrixcd <br /> with its "Che Tank-rfackin; Sheet is to be rctumed in Public ficalth Services, Fnvii0lu finial Health <br /> Division within 30 dnvs of acczptance of the tank by the disposal or recyclioy, faCiliiY• Ttm permit holder is responsible for <br /> Ensuring that this form is Compictal and returned_ <br /> FACILITY NAML::�_, =SLAC•L -- <br /> FACILITY ADDRESS:_ � �— <br /> TAMC IR p39 - pj- TANK srZE: ;Z1 PREVIOUS TANK CONTENTS: <br /> pop#iRWW%%%i EEM%+i%iEYMErTiiiiiiiiiiR 9d Wpp pi#p WEYip4+FMf1'WWpppWp#WWWWWYp WYFpxiivi%Y%ipp W$Ei.biMYWi%YYikippl:!.AW <br /> SECTION 2 - To be filled out by tank removal contractor-- <br /> Tank <br /> ontractorTank Removal Contractor;_,_ �'�t <br /> Address: W(t1 � Ciry: 5 1 Zip: 9-rz, 2-ca <br /> Phone p: ( 249 ) �'�� etc TRemoved• - <br /> W YYiEi.1.kYYYYYiMMFit.iYtY#i#MM.�`iYxYYiYxYWMkWYitErrEkEYFMI/Y.Mi'.FFYI.iiiiE W FFM Wi�.kEy-iEE E'YkW pEFEFEiE`.KFk+Y WiNkEEYEFFF.i Yi <br /> SECTION 3 - To be tilled our by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: <br /> Address: City: zip: . <br /> Phone A_ ( ) <br /> Authorized representarive of coptr ter terrifying through signature below that the rrnk bas been decontaminated in an approved <br /> manner as required by Cad EPA. <br /> Name_ W. M.-tiTitlr. _Signature- Date A`` �S'• <br /> kk W ixx'YNYYYfFxi�sxYNirrrNiii#iYYh'MNi...WY9>'+�Nir.MMW W MAIpixYYWYW'y'�.rrxYYxYYERYii111kGIlEy.xiiY%TFFikYriE iY1MF%YEEMW*MWkEY <br /> SECTION 9 -To be signed and dated by an authorized representative of the rrattracat, storage, or disposal facility <br /> accepting tank and/or piping. <br /> f <br /> Paclity Names FEST /T <br /> Address: .,...?6 71±Sx(� `—oleo ' City: 7& l4G�- Zip: :� <br /> Phone#: (� ab_ c46 �T3?6 <br /> Date Tank Received: <br /> Nom- Tule sigpamm- Dam <br /> iFiiirf.ErY.'*.........,MIYYYMrrpaiM�liii.aNNN�..�i.'..Mf`i <br /> EH 23 046 (Revisrd 9/11/96) Page 10 <br />