Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC EWALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany eacli tank affixed <br /> with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: Rosenthal BuYlding — Rosenthal Trust <br /> FACII-PTYADDRESS: 24 South American RYra t� 'SMrtrtnn rA gS?n4 <br /> TANK M #39 - TANKS=: 500 PREVIOUS TANK CONTENTS: 'caste oil <br /> SECTION 2 - To be filled out by tank removal coattador. <br /> Tank Removal Contractor. Advanced Geo Environmental inc <br /> Address: 4005 North Wilson Way City: Stockton Zip: 95203 <br /> Phone X: ( ) 955 — 0601 Date Tank Removed: <br /> ♦a****r:**********,...r..�.*��**..*s******************�**********.******:r**.*�.a..ams*a.*>*s�::>.o-***********�..r <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor. Advanced Geo Environemtnal <br /> Address: 4005 North Wilson .Way City: Stockton Zip: 95205 <br /> Phone #: ( ) 467-1006 <br /> Authorized representative of contractor cerafymg through signature below that the tank Naas been decontaminated in an approved <br /> manner as required by Cai EPA. <br /> Name: William Little: Geol oai gt Signantre: Daze 01 <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: West Coast Equipotnent <br /> Address: po Box 2368 City: Turlock Zip: 95381 <br /> Phone#: ( ) 668-9378 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />