Laserfiche WebLink
SAN, AQUIN COUNTY PUBLIC HEALTH SE CES <br /> ENVIRONMENTAL HEALTH DIVISION` <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> rtrr»+++r+rtrw+r*r+rrtwrr+*»+++rt+++w»+rrtrt«+r+»w+r»rt+**»»»*»+rt»»«w»»+rrtw+»rrrt++r+++rrrr+*+*»»w++rw++++»++»wwr«+ <br /> SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> this form is completed and returned. <br /> FACILITY NAME: FOULEP,'S <br /> FACILITY ADDRESS: 405 N. -DISON STREET, STOCKTON CALIFORNIA 95203 <br /> TANK ID N39 - TANK SIZE: PREVIOUS TANK CONTENTS: <br /> +»wrtwrtrt++rr+ww»+«rwr«rrr+w»+rrrrwr»rrtrr»+»»»»++r»r+r+*r++»+r+++«r»+rrw++»++rwrr»«»»+rw»+r++w+*rwwrw»++++«w+ <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> JAMES J. 'riOBLITZELL <br /> Tank Removal Contractor: <br /> Address: <br /> BOX 30331 City: STOCKTON,CA Zip: 95213-0331 <br /> Phone q: ( 209 ) 943 7793 Date Tank Removed: <br /> +rtr»++rr»+wrtrwr++rr+*r»»www*r*+»rr»+r+rtr*+rtr++rar»r+rrrrr»++*r+++rt++rt+r»+r*++w+r»»+*++»+rrrwrrrrr+rr+r++r+ <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: SAME AS SECTION 2 DIRECTLY ABOVE <br /> Address: City: Zip: <br /> Phone p: (� <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 /> Name: <br /> Title: Signature: Date <br /> «+»+«rw+r*»rr+*»*rrwrrr»wr+++»++rr*rrrrrr*rr+r»»rw»»rrr»+rr►w*rrr+»r++r++rr+rrrrrr»rr*»r+rrr»+arrwrw+rww+« <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 EOUIPMENT <br /> Address: BOX 2358 City:TURLOCK,CA Zip: g53Rt <br /> Phone N: ( 209 ) 668 9378 <br /> Date Tank Received: <br /> Name: <br /> Tide: Signature: Date <br /> rt»*»wrtw»r++*»+**+wrrrw*wrtrt+**»+r*»»+«wrt»rrr+w»r«r»+wrr*++»+*+»»*rrwwwrtwrt»«r*»wrrrr*++++r**r+rrr»+»rwrr«r+ <br /> EH 23 046 (Revised 10/19/98) Page 10 <br />