Laserfiche WebLink
10/17/2000 09:00 2094683433 FIFTH FLOOR PAGE 18 <br /> SANTOAQUIN COUNTY PUBLIC HEALTH SERVIC65 <br /> ENVIRONMENTAL REALTR Dpa_%ON <br /> UTQIERGROLWU STORAGE TANK MSPOSMON TRAC131YG RECCMD <br /> rr f#NMN rttNNr#f f!}lirwr•}}}}iwwa rr..ata.....r4.}z}Rii###}►rtfhhthrtrr Ntlrrrrrrrrr NrrNrrlNf flrr}}if# <br /> SECTION 1-Public Health Services Sirwilo L:Proal health Uivieion Tank Trde"Sheet ahan wwmpmy each tank affixed with <br /> its site idaritillcadim member, Thr Tank Tracking Shat is to be retuned to Public Health Servicr s Eaviroa7mente Healgh Division <br /> wlthtn 30 days Of acceptance of the tank by the diapoael Or rccytling facility. The permit boldrr is rmpotatble toretmaing that <br /> ibis form is completed and retw=d. <br /> FAC1LMNKME:__J?ACIIC AVENUE ARCO <br /> FACILITY ADDRESS: 6425 P A C Q E I C AVENUE <br /> TANK ID #39- TANK SIZE; 10. 000 PREVIOUS TANK CONTENTS- GASOLINE <br /> ••Ntl Mrrrrartlrarrgrrw.Nrrr#pRrrtlrrrrrfNN s rr rrMYrrMrMrppr►Mr1#prYr•/rYyfrrrrrrpyrrrr rrr#r frrrr <br /> SECTION 2-To be filled out by tank rcmovai mmactor. <br /> Tank Removal Cvntnctor: W. A. CRAIG. INC. <br /> Addmn: 6940 TREMONT ROAD City: OTY0N Zip: <br /> Phonek ( 7 0 7 ) fi Q 3—2_92_9_Dem Tank Removed: <br /> .tisirab MrNN1f tlspprrrrrr#Nrr urtla rfrrrrrwrrrrf a tlrfrfr•tlM►tl MrfuNrrtlrrrgrpr###rrrrrtl Nwa} <br /> SECTION 3•To be fltled out by opntrattor "deeooFatninat rank": Q OIE S ry c7 p Q 4 t�I <br /> Tank Decontamination Contractor: <br /> Address: City-.`- ZIP: <br /> Phu=/: <br /> Aurhotized represeetative of eoritrutor certifying thmugb slrnatr¢e below drat dte tank has been d cantanimat d in an approved <br /> manner as required by Cal EPA. <br /> Name: LELAND, YTALFL_L� Title: N. MANAGER S _ e. L-DareflCTl1RFR 1R_ 2000 <br /> rar►r1UMrfr rrrsrrtrryrwrf Ntirrf NrrrrMN•rrrrr rrrrr 0,0414rahs►NNflfr"rrrraru Nrrrarr O 0""a pase"00 <br /> SECTION 4-To be siped and dated by an authwhoed repreaetitatire of the tr atmeot, SWrage, or disposal facility <br /> stepting tank and/or piping_ <br /> Facility Name: <br /> Address: Clry: Zip, <br /> Pbene 9: L� <br /> Date Tank Received: <br /> Name: Tide: Signature: Uarc <br /> ssrsarrrrr.rurrarrff#rr.•apple r...s.rNwwsrrrMr##++sssafaxihr.....r+.rrrrrr....... .6.....urrarrsr.rss <br /> EH 23046 (Revised 08113/99) Page 19 <br /> OT In 3NI 9IVH3 V M 9Z6Z £69 LOL %Vd 99:9T 00/£Z/OT <br />