Laserfiche WebLink
a <br /> UNDERGROUND STORAGE TANK DLSPOSMON TRAC3M4G RECORD <br /> stssssssssssssassssssssstssssssssssessssssssssrssstsssarsrsrrssrsssrsrstrrsssssssrrsrssssrstsssasssssssesss <br /> SECTION 1-Public Health Services Trading Sheet wM aecampsay each tank*W=d with its site idendfication nvml= <br /> The T=d#g Sheet is to be returned to Public Health Seaviees within 30 days of acCepiaaoe of the taut by the crkposal or <br /> poiding hcMly Mo permit boida is raponsible for mmiag that this ft m is complaed and retw.- <br /> FACn=NAA 1c<�N G S s L AN <br /> FAC nY ADDRESS: ZN 33 y _ W . STATE <br /> TANK M #39- Tank Descriptions so0 6A�. . S tNG� c�Att, STa.£l <br /> srsssssssssssssssttsssrssattssststesststsssssrserrssssasstssrssssrstrssrasss•srsasrtssrsssssarssssssssrssast <br /> SECTION 2-Tb be mkd out by tank removal contractor. SEa 4 (EQ i0WM 1 PA(vE 10. 1 <br /> Mu*Removal Contractor. �L.Q �c�►�- Z=�?y�Ror��rn f�•—q� SF z►v�C fS } iNC. <br /> Address: y ZZo Com►ch Fite�Q►L R. .4 S;-� S City:_; C A Mr. _q S a G <br /> Phone k zcR >r 33 —wall 5 Date Tank Removed: <br /> rsssssasss:sssssass�sssssasssssssssssssssssrsssssssssssrsssssssr:ssssasssssasrrsssssssssssrsssssrsrssssss�s <br /> kON 3-To be filled out by contractor•decontaminating tank" <br /> Decontamination Cbnnraccor. w �GNT r\,vi Reern E,a t, S ='N C. <br /> Address: ti.t iZv _Q_ra ,m eA aL tQ 4 9=- ra s Cltys �N'LA ti CA Tag q5 3'76 <br /> Phone A ( lack) '833 — Cr?SS <br /> Aathotiaod reprrseatative of contractor ocrtif*g through signature below that the tank has been decontaminated in an <br /> approved mamma as rogvired by Cd EPA <br /> We: <br /> sssssssasssssssssssssassesasssssssssasssissssssssrssrssssrssssssssstssssssssrsssstrsssssssssrssssrssssssrss <br /> Ng TION<-TO be signed and dated by an au&uJaed aitstive of the treatment,storage,or disposal lhcMLy <br /> aaxptfag tank aadA pipk& <br /> 1tyNames t�?�Aw1GlE ACQAtrE +t - - <br /> Address:_ 3S ZS SZ Hfl AvEn1 v E Q 1'an% SFae�tam, ,m i Ca- Tg q59 T3 - <br /> Date Minh Receive& <br /> ssssssssastssttsssrssssstrstssrssststsarsssrttsrssssetsssrsssrsssttssrssttssisssstrasssssssssrsssssesas <br /> cygiffew 7.10.r <br /> pa" 10 <br />