Laserfiche WebLink
ADDENDUM TO PAGE 10 <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br /> The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br /> recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: RMC LONESTAR <br /> FACILITY ADDRESS: 30350 South Tracy Boulevard, Tracy, California <br /> TANK ID #39 - 3 & 4 Tank Description: Single Wall Steel (2x1000 gal) <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Pacif is Excavators <br /> Address: P.O. Box 968 City: Alamo Zip: 94507 <br /> Phone #: ( 510 370-8783 Date Tank Removed: 1/24/96 <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: <br /> Address: City: Zip: <br /> Phone #: (� <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA. <br /> Signature: Title: <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Erickson Inc. <br /> Address: 255 Par Boulevard City: Richmond Zip: 94801 <br /> Phone #: ( 510 ) 235-1393 <br /> Date Tank Received: 1/24/96 <br /> Signature: See copy of Manifest #95893857 Title: <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />