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SAN Jr 2UIN COUNTY PUBLIC HEALTH SERV ?S <br />ENVIRONMENTAL HEALTH DMSION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />...........*ir#fi.....*iiiYi#fiii....iiYi.#.iiiYiiiYiiiYitiY..ri#Yfiiiifiriii.r;.iYfi\ii......iaiY#fiiii..rir.irr <br />SECTION 1 - 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 />itis form is completed and returned. <br />FACILITY NAME: Gateway Proiect - <br />FACILITY ADDRESS: Block bounded by Lafayette El Dorado Center and Sonora Street <br />TANK ID #39 - TANK SIZE: 1.500 pal. PREVIOUS TANK CONTENTS: Unknown <br />r...r.rr........... rfifii.ii......ir##riir.........i.irrriiiiYr#ii................. r#ii......... rirr.......... <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Evans Brothers Inc <br />Address: 7589 National Drive _City: Livermore Zip: 94550-8803 <br />Phone #: ( 925 443-0 Date Tank Removed: <br />.................. Q.iii......iitirYrYitii#.... *..a.iYir.ilii.#ii......i.i.i....**..................... <br />Viii# <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contactor: Ecol oey Cont of Industries <br />Address: 255 Parr Blvd Ciry: Richmond Zip: 94801 <br />Phone #: ( 910 ) 170-7462 <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 />Title: Signature: <br />Date <br />.r.r.......r..r.ir.rrr.rY.......r..r.fi....iarr.wiirrrfit..rrrr.fi.irr..r..r.*.r. <br />SECTION 4 - To be signed and dared by an authorized representative of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />Facility Name: Fonlogw Cnntrnl Tndu G ri ec <br />Address: 9%1 Pnrr Blvd City: Richmond Zip: 94801 <br />Phone #:(s1 nn ) q7()-7462 <br />Date Tank Received: <br />Name: Tide: <br />Signature: <br />Date <br />.......r......i.....i..i.............ir..ri*..r#riri......i...ir.ii#..iiirM.irr#.sis..r.irrit.iYirrir.. r# <br />EH 23 046 (Revised 10/19/98) Page 10 <br />