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ao/al/ronn fly: E71 6689382 DOLORES BAPTISTA PAGE 01 <br />iirr-Jq-GGl'7b 1{017 <br />P.@2 <br />/ SAN JOAQUIN C'OUNTV PVPLIC HEALTH SERVICES <br />ENVTRO"IENTAL HEALTH DIVISION <br />LTtDERGROVND STORAGE TANK DLsM%TITOttf TRACKING RECORD <br />........,r.......r........«............... ...... .rr......... .......... r .... «....... rrr'r.... 0..... a.... 0... <br />SECTION l - Public Health Services Envtrontnenwl Neotth Division Tank Tracking Sheet shall accompany each 1111[ afdced <br />unth its site identification number. The Tank Tracking Sheet Is to be returned to Public Healm Services Eavicontreaul Hadth <br />Division +Itbia 39 tiara of acceptance of the [attic by the disposal or recycling facility- The persR holder is tesponsibls for <br />ettruring that this form is completed and returncd. <br />FACILITY NA, <br />FACILITY AD <br />TANK ID JP39 -,0kJX Z -U TANK SIZF "n—PREVIOUS TANK CONTENTS:��Iv�7I+k+ <br />N-.'..�r.w..'.�.".0 N..IN.N..M r/ N.Hrr....rr•M.r..r N.r Nr.rr...rNw <br />SECTION 2 To be filled out by tank «moual contractor. <br />TaRemnvtJ Contract"* cr <r �.�� �� <br />nk e^r <br />Aadrael ( v. e.el � ;.� _ city:`— :� ct Zip: %'3 -CSF <br />"am N(%+r`�1 vK''I—E�31 i ` Date Tank Retroved'— .— <br />.....+tr.....1........rU..•.rr...........r•.......f.............Y..r.....rrN.r.......r.r.....N.•••......a- <br />SECTION 7 - To be foiled out by contractor ,decontaminatinit tank": <br />Tank Decontamination sa <br />Camctor,ya �nL {+�J;v "1Nr <br />Addnaa. s'o J'J✓yt_.�.iJ3t`_ ciry-jk <br />rn ziP' `ls-tc;� <br />— — <br />Phone P' ( F CK <br />dacoatattrin <br />Authotistd representative of conttxtor ttnifying through signature below that the serol[ bt?CA.-. _ ated In an approved <br />- <br />amauter as required by Cal EPA. rj �} , <br />Nxma./tff 14' �*rIt _Tide: /' `Y tgstDau r^/?'Cl�i <br />♦ HL.. ♦N <br />0...0-0 •......,.•.......•...r 1.........•..... •..f 4..p...FNM..e.N•..N...NrY.•........!•.•r. <br />SEV"ON 4 • To be signed and dated by an aahoriaed re mentsid" of tbs treatmnt, stottige, or disposal facility <br />accepting tpnk and/or piping. <br />Facility Narnic <br />Add". 170G' /Veru_ Vt1,4 L�y[cT_ � City L[l24 r: Zip �/S 3 <br />Phone # <br />Date Tank Rcceived'S °� ---- <br />YNwm. _ ide:�(�—�58naturc: Dale <br />/`r..wr..r1.....'I...A..rrrN......r........I...............r........«rsN•r N.Nru.o N.N.N.Nrr.Orr N.. <br />FH 23 046 (Revised 9/11196) Page 10 <br />