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bz 14-2NL1b 12:29PM <br />FROM SEMCO <br />SEMCO <br />TO <br />James C. Bateman Petroleum Services, Inc. <br />1217 South Ah Street, Modesto, CA 95351 <br />Environmental & General Engineering Contractors <br />License No- 449864 A, B, C-61ID40 <br />(209) 524-9653 <br />TANK DISPOSITION TRACKING RECORD <br />4640138 P.02 <br />SECTION 1: A Public Health Services Tracking Sheet will accompany each tank affixed with <br />it's site identification number. The tracking sheet is to be returned to Public Health Services <br />within thirty days of acceptattce of the tank by the disposal or recycling facility. The permit <br />holder is responsible for ensuring that this form is completed and returned. <br />FACILITY NAME: John & Cheryl Mullenix <br />FACILITY ADDRESS: 515 1` Street, Escalon, CA 95320 <br />TANK ID: 99-5270-1 <br />TANK DESCRIPTION: 4,000 gallon gasoline underground storage tank <br />SECTION 2: To be filled out by tank removal contractor. <br />TANK REMOVAL CONTRACTOR: SEMCO <br />ADDRESS: 1217 S. 7th Street, Modesto, CA 95351 <br />PHONE: (209) 524-9653 <br />DATE TANK REMOVED: 10/22/99 <br />SECTION 3: To be filled out by contractor decontaminating tank. <br />TANK DECONTAMINATION CONTRACTOR: SEMCO <br />ADDRESS: 1217 S- 7th Street, Modesto, CA 95351 <br />PHONE: (209) 524-9653 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in�ov�margter�e7iy he State Department of Health Services. <br />SIGNATURE: 1Y/'/"�TLE: Agent for owner <br />SECTION 4: To be signed and dated by an authorized representative of the treatment, storage, <br />or disposal facility accepting tank and/or piping. <br />FACILITY NAME: Modesto Junk Company <br />ADDRESS: 1403 9th Street, Modesto, CA 95354 <br />PHONE: (209) 522-1435 <br />DATE TANK RECEIVED - <br />SIGNATURE: A <br />Z:CEIV]E SIGNATiJRE:/��ff`/'// <br />4, O&D <br />30 , 700 r_ <br />TITLE: <br />TOTAL P.02 <br />