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• UNDERGIOND TANK DISPOSITION TRACKIO RECORD <br /> ***�*******�***s*•********:***•******s*****«***s*s****»:*•********:*s••*******s**s*.**s****s****•********s <br /> SECTION 1 -Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. The <br /> Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling <br /> facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: Law====Livermore National_LLboratory(LLNL.) Site 300 <br /> FACILITY ADDRESS: Corral Hollow Road Tracy Califomia 94550 <br /> TANK ID #39 - Tank Description: ?$Qgalton cense' .ci le-walled.carbon steel=k <br /> SECTION 2-To be filled out by tank removal contractor. <br /> Tank Removal Contractor. LLNL <br /> Address: Corral Hollow Road City: Tracy State: CA Zip: 94550 <br /> Phone #: ( 510 ) 423-4881 Date Tank Removed: _ <br /> SECTION 3-To be filled out by contractor"decontaminating tank": <br /> Tank Decontamination Contractor: N/A <br /> Address: City: State: Zip: <br /> Phone #: ( ) <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> 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: T awrence Livermore National Laboratory <br /> Address: Corral Hollow Road City: Tracy Zip: 94550 <br /> Phone #: ( 510 ) 423-4881 <br /> Date Tank Received: <br /> Signature: Title: <br /> EH 23 049(Revised 7/10/92) <br /> 10 <br />