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SA_`-OAQUL`I Cowry PUBLIC HEALTH SERVICES -K <br /> EN-fMOlYMEyTA, HEALTH DINMO- <br /> M�MERGROUND STORAGE MLNFIC DISPOSITION TRALCIMNG RECORD <br /> SECTION' 1 - Public H,-alto Sr.rices Eavironmeacal Heatu DiVi.sion Tank Trackias Shee: sh ri ac-Omnany each rank <br /> Witt its sire Edendflcadonnnmbe:. The Ta^; Tra=kEna Shee: is ro be reamed cc P.tbiic :_e 1CR Sr, ices Eao onmeaca Fa lrn <br /> Division within 30 days o[acce�cance o;nae ra=4 by the dispcsi or .-ecv^irn_ Lciliry. Tae permit holder is =sDons;oie or <br /> e=-driaz tsar =is for is comnie:ed and recrraed. <br /> T <br /> ACi_.r Y v;tic:_ S c, )- S !� 6r7- Y- �r cts <br /> FACT-r= 2 G A WP- s T 7-� r v, e r R Q �� <br /> T.ktix ED =_> - T--�-vi< SiZ- i0, 00 0 PR -vio s T_Vii CON'TmN. :S:_(f� d. r`r2ln <br /> SECTION' 3 -_ be 5i%ed ant by tank re.-nova! conrr-actof»y»»>_»•»»»»»»>•>_�»»_>i»»»»»>_»»»»> <br /> Tars Re=cvaE Concacmr. t T-e- it C G -it c 6 v S <br /> Address: -- 2 ? ti o", ;. ./C• �k. Fc c!c �o t rp: {'-'J�' G' <br /> P!:cae ._': ! "T6 9 ? 4 / 6 3 7 Date Tank R.:=ove-: <br /> ».»>»» »»_» <br /> SECTION : - _o be =_eed ocontractory contractor <br /> ! <br /> tor "deccoonntaminatins mak' y »»>•»»>y>_>•>•»•>•>•»>_ <br /> Ta-r Dr_cnr'—,^-^on Czamm--.r: _ �F- .- , / e 1Z e O til / —k-eL c <br /> Adc_s S 3 GL i S <br /> 1-c.'a wl {�, Ci^r. /GC <Zcx ZED Cf SGS <br /> P.u,dor�ec :_�r�e,.r»ve oc c..ncror r.�r;_e z-hronasw, z-m beicw :mar t_ .=r :az . <br /> 3= zrcrcv� <br /> _te=e: as tc=tc by C'Zj - r.. <br /> Nn—e: ELe: l�'�3L'L'e: tar <br /> e <br /> S'r CTIO ti To be sir-' ne dated iv an authorized repceseacari ,. <br /> ve aPe - _rs sD <br /> or d esai ;ac iirr <br /> ar_e^cins:=k mcior piping. / <br /> Factliry-Ya=e� l e S T (�rs ct 5 i= Q u- l h <br /> i <br /> Address: 70 o We .t f Wea- /-�, T eiry:T r 'o c 7.0: <br /> otione.s: 0Oa > l y R — 9 3 7 8 <br /> Care Tank Receive: <br /> .4=c: %de' Sig:anue• Dare <br /> EH 23 046 (Rerised 9/11/96) Pale 10 <br />