Laserfiche WebLink
12/18/98 FRI 09:33 FAX 5106004 RSL BESI N GROUP RHL P&IALUMA 49011 <br /> SAN 30AQUIN COUNTY PUKJC MkLTH MVIM <br /> owmOMMMUL HEALIM HEALDTV MON <br /> UNyLyERGROL'ND STOR.jGE TANS DLspo ON TRACMNG RECORD <br /> SEMON 1- Public Health Services EuvifoWnemal Hear Division T=k Tracking Sheet strap accompany each tank afLxed with <br /> ices site idcatification number. The Tank Trading Sheet is to be r=Zed Pubiw Health Services EnvIrcOmenmi Health Division <br /> w,tirin 30&M of=ap= c of the tank by the disPosa; or recycling famly. The mit hokler is responnble for ensuring that <br /> this form is completed and.returned- <br /> FACR.i*f'Y NAME: . , y 2 o ar r S h e l{ <br /> FACILTFY-ADDRESS: t� Ia � . 04Ar4. r a <br /> 'YANK ID#39 - 0 q C _C) LTANK SITE: (0, )ao PRE OUS TANK CONTENTS: G i1S 0i,tN� _ <br /> rraeh�M.sr*�Ms%ui�+R+kk�kFkwk�WM�MF� s�c� i <br /> SEMON 2 -To be filled out by tu& removal coatr - <br /> Tame Removal Contrat:tor: <br /> Address: OD OLD Cor-'+ ,10 fz¢ City: w76dr ip: 132 is <br /> PhoneI( [_ ( _? -8 S S Date Tauk Rcoved: <br /> SEMON 3 - To be tilled.out by contractor"decantaminaling t=k`- <br /> Tank Decontamination Contractor: crashD11er <br /> Address: O. 2.�t ST. City: pet kl4nn Zip. <br /> Pie#: { Ea3S- 033 <br /> Authorized representative of contractor cerrifying through smote bel w that the tonic has been decontaminated in in approved <br /> tt w=r as required.by Cal EPA,. <br /> Tide;(ar'r1 � nue:4&== <br /> Dace <br /> .r*wr.}�raa*srr* �sr�a �►w�rr�.ar,��+. *�»�r�*�se..w +�+re <br /> SECTION 4-To be signed and dated by an authorized rgpreseiiYe of the tttatradat, storage, ar disposal facWrY <br /> accep�nx tank andlar oiaiust. <br /> i=aeility Name_.._..-.�,�.. <br /> Andress: ,2 �L city: X-71 <br /> Date Tank Re�iv� Ixo � % 1 <br /> Name Z/� T'ule+ 57}f C.C/O - S" ince: Dare <br /> -� ER 23 W (Reoisett 10/14!9$) Page 10 J U L. 0 7 1999 <br /> ENVIRONMENTAL LTH <br /> PERMIT JERV CES <br />