REMOVAL_8_31_94 - Laserfiche WebLink

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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD ......rarrrrr««rrr..r.ra««..aarr r r« r s r r a r« r. r r r. r r r r. r. r.. r...r *.0..r.«r«sa r r r r s r r r... r«rrrr......r.r..rr. SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. FACILITY NAME: 'A iA T FACILITY ADDRESS: S(XJCi a `,i PC) � TANK ID #39 - Tank Description: So G! <,1 rsr I ............««.«..«.«..raraaa•raaa araaaaaa a•rara.♦rrrr..rr.♦rrrrr rrrrrraara••aa.....r.aaaaaaaar.....sraarr• SECTION 2 - To be filled out by tank removal contractor: Tank Removal Contractor: ARONSON ENGINEERING, INCORPORATED Address: 6809 McComber Street City: SAcramento Zip: 95828 Phone #:9( 16 1 381-1600 Date Tank Removed: ♦.•r«raasrrtrar•aaa••a•♦raagaasrsrttrrrrrrrraaararar••argraprssrsrssrrrrsraa•♦rasusaa»srssrrrsaarrrp• SECTION 3 - To be filled out by contractor "decontaminating tank": Tank Decontamination Contractor: ✓l %� Address: City: Zip Phone #: Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA. Signature: Title: rr.rr.rraas••a•aaaaar•rrrrrr.aaraaa:raaaaarssssrrrrr•a.aaaaaaa•sssssssssarraarrsssrsrruraargsssssssarrar• SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility accepting tank and/or piping. Facility Name: ERICKSON INC. 255 Parr Blvd Phone #: ( 510 ) 235-1393 Date Tank City: Richmond Title: Zip: 94801 ♦.»r«.r..r.r.r...««a««««r«arrrraaaara•arar«r.rr.a«r«rrrrrr««rarrrsaaaraaraaarr♦r rraaaaaaa a..aaaarsrsssr EH 23 049 (Revised 7-10-92) Page 10