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05/10'99 09:19 FAX 425 251. 8782 BARGHAtTSF.N U004 <br />SAN JOAQUIN COUNTY PUBXIC HEALTH SERVICES <br />ENVIRONMENTAL EWALM DIV7S5}rON <br />UNDERGROUND STORAGE TANK DM?OSMON TRACEING RECORD <br />.w*wwar'`�" rrtt.+h*+�+.wrwrrtss.e.r�rr,�raorw+aak+swr�ss.s*aar�a«rr....rs++++rww*,r+r«�+wwsr�k*k+�.a*s�aR.� <br />SE�`YI(?L�i 1 -Public HCW(h Sezviees Euvi�tal Health Division Tank Ttacidng Shea shall accompany cath teak affixed wish <br />its siu on minilxr. The Tank Tracking Shcxt is to be t>:tutncd t0 Public Health Services Euvimnmcmd Health Division <br />wf of ACcepUnee of the tank by the disposal or recycling facility. The permit holder is responsible, for ensuring that <br />titin form is Ieted and reaumed. <br />=ACIIITY NA tifE:� iPL°Ej :/V <br />FAcll.rrir AD DRES& %ta 1,4'>l SR -'`k- Tom+! rte. <br />CAM ID439 _ TANK SIZE`:: /2 -PREVIOUS TANK CONTENTS: <br />MW/�r**#*�e�e #wgrWaayrrtrw*arara*,w �MtM ��a.�7V/C — <br />isW'+sMwMFt�larywhM�s*F* W,F*+�;'**rrxst�wst�+sem W{,alesMcwM �WaYy <br />3 <br />7MON 2 - To be •filled out by tank removal conu-Aaw: <br />1 <br />'auk RemovW ontxActor: 0 f;7-1-4-9 , RYAW N , <br />.ddrass: 10-797 S/E4eA214, 27- City:`zip: <br />hone a: S /.- 74g4 Date Tank Removed: <br />«rs+uR*►iF.rs�,s,k,i+krta�r�opr{.a�,µ,sryu{ukn,e..►Mrt�e�R+MrWir+�MWW��.saA4+Yis-�syr4irrrr+t*Rk+N kY.rt+wwYAriiaaw+Y tl.wwer..sritwwk <br />ECTION 3. -robe filled out by conhactor "decontmnftciating tank": L/NOCl2 k�3 ►7 7- <br />on Conacacwr: � <br />ddr+txc• _ �-� �� 2 t3�t/� City:Ile 'P11$ -V zip: <br />conn - �3��=/�7: 7 3 <br />orh�. � r ale of conaaaor oaZi€ying to novo sigtlatara below that the task has beta decodtamivarad m as approved <br />saner u : by Cad EPA. <br />3II7G: Time: S-tgnatQrc: <br />bue <br />i <br />4b��r*Ygt1tM�Fs�y['kY*+e*r*qAc W*kkf+�r�/y�+rs yaMIcMrW rukt <br />tCT1ON'4 - be dgrned and dated by an aadwiixed represent:dye of tb6 treatment, norage, or tftsposai fact7.try <br />jtank =&or piping- <br />MMty Trams: i �G� <br />Idress:��� r�3,�i� /.Ll� city--. Zip: !-A% <br />7 <br />out d►: (��Z�) ��i �� ���/" <br />.te Taak Recet ed: <br />me: Tide: Siguantre: Dace <br />+rfa.ticaar+rpi h+M,kaawr*wssuMr�*�ynWks►,�afw�q+NMHu.ass#rwK�+ars�a4.kkM.rsswt+R*,Ytttic�rs�. Yrie ikrts.Wkkrrt��ArMMY rs�,kit <br />-23046 (Revised 10119198) Page 10 <br />1 <br />