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Dec 16 98 10: 19a Elite IV Contractors Inc. 209-461-b34G V. , <br /> WE�COpST EPV IP SALES 1 209 66E 362 P.031 , <br /> Contractor! Inc. EOS-461s0342 <br /> Sit: Lb ea 10: 210 <br /> Elite IV ... _... . _ _- . <br /> SAN 70AQM COWrY MLIC HEALTH SERVICES <br /> ENVIRONMENIAL HEALTH DIVISION <br /> U"FRGR011ND STORAGE TANK DISPOSITION TRACKINti RECORD <br /> ..................t:....... ..A,.+.r.x....wr......x............u................................... <br /> SECTION i -Public Health Services Fmviro mental Health Division Tank Tn acg Sheet sbail accompany each tank aY, <br /> with its site ideotificuionnutneer. The Teak Tracking Sheet is to be recamed to Puhlle Health Services Fal I otVncnul ift, <br /> Divisim vrtthin 30 day of aceeptsoee of the tank by the disposal or recyclxcil Wlity- The-permit fielder is responsrot.;-- <br /> tosuru+g that this form is completed and remand. tt�� 4— <br /> FAC1L11Y NAME: Y oa S i 0 s 81i ..�- <br /> '1't OL 9 <br /> FACR,ITY ADDRESS:__x4��1![Q f2 , AL,J <br /> T..t,NK ID #39- _ TANK STLE:.10�-M),_PREVIous TANK CONMENTS:_-_ v a2_k.Lt2. 4"L. <br /> ..ra.a...v.w.....avuwo.w ......n......n.A.w...................r__,.--. --.-. . <br /> SFC'nON 2 <br /> -_-9gToGG be fitte�d a`te by tnek raa_oyalw : <br /> laak Removal Coaua"Or F- IiA .-Ir - CO'K- o a C D <br /> U• S <br /> Address' yc/l;wi. bir. City: S reel<76-om ._ <br /> Zip:__��-2 r r_ <br /> Phone P: 1�+�L1. �l 1 `��v�� 7 Dau Tank Removed: <br /> ...........A........f.............N.....r.x..Y.... ........a................r...nwwr• n— n -_.. . <br /> SECTION 3 -To be idled out by contractor "deoontemlasdng tante <br /> Tank Desontasmoaiton Contractor: E I t e '47" •carr A r7'L[r s <br /> Address: `Z5 3a G 0 9 k/d- VV%- 3� Y- city: 57�*(,A a zw:•-,,,,,�.� s <br /> ?!tone r. ( O Y y (� / - 'J ---.W... --... <br /> �uthmi:.cd reoreseata[ive of catsiractor cenifyia3 through signature beton shx the tank has beau accotnamioatea m an aL s: . <br /> :narme-.as tequued by Cad EPA. <br /> dame: S t A C 7ide:Co n GL/rRu '1 Signatns4a�_f�E /GGeLL__Daze /�-/2^qb <br /> ................. ...z.......w......a.r.=...r...........o................. v>.......r.r................. <br /> , <br /> SECTION 4 - To be signed and dated by m sothorlged representative of due tteandc3t,steraga,or disposal racdrr• <br /> acceprta;rank and/or�pii�pin_g.. <br /> AwAddresa'- y— -1,36d( clty: iz+� <br /> Date Tank Received:_.. <br /> Name: � .tf IORa^��G�.e�,(J, Title.�'K'')"i-fit--' Si;nuutt: s"'�•/ ! �_._...__.._.. <br /> ♦..n....+.1.........._._....'.J.—..�iY.............e.....t.wa.l....a... .. .'...................... <br /> EH 23 Oa6 (Revised 9/lt/%) Page 19 <br />