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Dec 16 96 10: 19a Elite IV Contractors Inc. 209-461-6342 p• 4 <br /> 1, — T COAST EQUIP SALES 1 269 6 9382 P.01 <br /> `/ Ott► <br /> Dec 15 86 101058 E13te -IV Contractors Inc. 208-461-6342 - r <br /> SAN JOAQUW COUNTY PMUC gBALTA SEILVICES <br /> ENVIRONMENTAL HBALTf1 DM90N <br /> UNDERCROUND STORAGEUn DISPOSITION TRACIONG RECORD <br /> _,.....�.........a..........»,.,.....,.........«...............:..,..«en shall xcuospang'each wX .f^::... <br /> SECTION 1 - Public Health Services E"vironmemal 1lcalth Division Taut Tr <br /> aoft Sheet <br /> with its sire identification number. The Tank Tiackw8 Sh�usao!o fecu IC ind tfac ty�The permit buid He-9th Servicesvis m5 roos�-ti ie t i <br /> Division within days of a,cepiwe of the rank by theP° y y <br /> ensuring shat this form is completed wd cecurntd. <br /> &VT G4 <br /> 7ACILRYNAME:,_ I S�°r �y • <br /> pA <br /> FACILITY ADDRESS: A O_ �.fl r? /-x___ <br /> TANK SIZE'J-D_Q�0 p&EVJOUS TANK CONTENTS:-ldj—R4 SV3 - <br /> • ........I.........:.e..............:..er..................................,................. <br /> ....__., . <br /> SEt_710N 3 ro be tilled out by tank rtmoval contractor: <br /> Tads Removal Contracroe L-f-.L-. <br /> Phone 6: (�>O�). . �0 1 'fi 3 �,_Date Tank Removed:­.­­—, <br /> _ <br /> ..................v...........+..«...................................... . <br /> SECTION S To he fired out by eomraeror "decontaminating lank": <br /> m r� ToU`S <br /> Fank Deconrautiaation Contractor: -lit Co <br /> -� <br /> Address: <br /> '.uthorizea repfesenntive°f conaactot atttfying throueh signatum beiow that cite rank bas been deconumtnarrd <br /> .taatet as required by Cal EPA. <br /> Dau <br /> a..w..a.we...�..«.....«as.aa..ti...i........a....«.....:«...«..a' a...w..a y...s.«....................-_. -... <br /> SECTION 4 -To be signed and dated by an authorized representatist o ' e txament,storage.nr Aispu.+el!:-alcty <br /> accepting task anNor piping. <br /> Facility Nzme: ('�,flw-�w"d,"r7T _ s . <br /> Address[_-... <br /> Date Tank Received:_- <br /> Name. <br /> Titk:_ <br /> ............................ <br /> ..........uav................................r........«.....w««......... <br /> `21,16,04 tn.vi.M 9111!961 Paye 0 <br />