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05 10 '99 09:19 F.0 425 251 8782 BARGHAUSEY J004 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> E"MOE`KENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DLSPOSPIIOK TRACX3NG RECORD <br /> rrr#i � rrW�w.�w et+wwsrrrara KWi�str+lokw.rrw��Ms+YYrtrrclwsFwrswsrtW#rlw��r'ayF�Rf6++eF4is#h+Yresti<[�uM <br /> SECTIOL P! - is Hcatth Sl--A= F.avtro=attal Health Diviaiaa Tank Trading Sheet shall i=Mpany each Lank affixed with <br /> as site . on aunibcr. The Tank Tracking Shoes is to be re=nd to Public Health Services Environtncatal Health Division <br /> within X of acacptance of site tank by,the disposal or Mcyding fsdliry. The perMit holder is responsilk for ensu Wg titer <br /> Isis form is feted and irn mrd <br /> AC1LXrY NA LEE: '4CL7Z -/ <br /> ,kCulrY AD DRIES& %0 c,, �w� �/.¢� S;-�k Til 44 9�ZE� <br /> LANK ID439 TANK SIZE: %ZPREVIOUS TANK CONTENTS: <br /> L %/-hv,k <br /> wrrsawrierrr rwrr<aarrsWrra.w.ws..vser.era.rv*air+.w4s++a+rw�a..swwwr■++a�w�ns<..wlaur+.R�rr�wrve.riwrri. <br /> �ECT10N 2--To be-filled om by tank removal oourtactor- -- — - - --- -- - -- -- <br /> . i • <br /> 'astic Brasov=!�trxtnr. �ETTLE,rZ ,rZy�¢�/ L�_�� <br /> .ddsass: 1 Ip7q 7 SIE'-�f _ G�2 T S�i�E�� Ci y: Ou44�'V Zip: 5'fsla�, <br /> i <br /> hone ff- SS/- 74 Dae Tank Removed: <br /> «...�lW wrrs.lp iloYMrtrV�o�swRswrcanY.a-+a+r�ss+MrWWre+.ywYr��.usrw�.ri+s+reflriraws<.W Mcrrrr.i.r�rr�..aa KW Mrrar«a..+rwc <br /> EC11ON 3.- o be Riled out by c=q-sctor"decontminatitt�tank": U•vQL 2 $C�jq,/' Te' 7 7- <br /> auk Dccbn on Cru acme C <br /> Adms: Ciry: ZfCZip: <br /> uthoriud r4r, vc of cottnxior oetufymg d=v#sig==below that the Lank has bees d_= an approved <br /> anger as iequ vd,by Cal EPA. <br /> Tt&: Dane <br /> -- _� <br /> +' .b+.+�e...u►+k+.r ,u.aK«W era <br /> =40N'4- be sig*d and dated by an-r1f dzed cepresmaaye o€the trt=em,storage, ar disposal f Tity <br /> Ving tank and/or Piping. <br /> czZity Namt: <br /> (dress- Cuy- Zip: <br /> one � z3s— i3S 3 <br /> m Tank Rc= ed: <br /> Tule: si <br /> tom- Date <br /> �r�rtMr.LLarr'*+YYasw�Yrr+urw+les�.tWy,ra'ww�rsaaa+ntiesstic+rwwra+sr�{ tra1s rsaaM,Yt+�aea.'w�.trra.«M4rrrr►WWWrr-+ea'+r <br /> i <br /> -23046 (Revised 10(19198) Page IQ <br /> I <br />