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09/07/2001 09:30 66893'- DOLORES BAPTIrTA PAGE 01 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> }rtM##!f#MM##Wi###M#ifi####i#+tifisiiiixxiifxsx4xsss+Mssisxiiiisssissssx Yixi+WYff WFW##WiiWW/fi}ii+l4sfsfsif♦ <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 /> FACILITYNAME: silveria Property <br /> FACILITY ADDRESS. 1933 Hiawatha Avenue, Stockton ca 95205 <br /> TANK ID#39- _TANK SIZE: 500 PREVIOUS TANK CONTENTS: gasoline <br /> rtlWi/WfMMrtfWi#W#W4M/MM#f#YY+sffsislf WiWWWWWf WMW##W#######W#####4#4W44444sisissi#>WWW####MM#M44issiix4YYi#s! <br /> SECTION 2-To be filled out by tank removal contractor: <br /> Tank Removal Contractor: advanced Geo Environmental inc <br /> Address: 837 Shaw road City: <br /> Stockton caZip: 95215 <br /> Phone p: ( 209 ) 467-1006 Date Tank Removed <br /> ssssYs##YW Yb####b###b#i/#tisisss WWWW#YMWrt#ffMiiy}siiisiiisisss#YY#if/#WNM##4##if ssss##YiMW##b/4141+sssss#f+ <br /> SECTION 3-To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: advanced geo enviornmental inc <br /> Address: 837 shave road Citystockton clip: 95205 <br /> Phone N: ( 2 9 ) 467-1006 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated M an approved <br /> manner as required by Cal EPA. <br /> Name: william little Title: geologist Signaturedrl(l��� Date <br /> if#i!!###i##fWWf■#!#W######4filssss#YWWMW}Mb##Mfff}}fiYs!#3Y3}}YWWW#iWM###Fs+Yf#!Y/##!####4#Y#WYWYti#####}/ <br /> SECTION 4-To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank andlor piping. <br /> Facility Name: west coast equipment inc <br /> Address: po box 2368 City: turlock ca Zip: 95381 <br /> Phone#: (209 665-9378 <br /> Date Tank``Received: 10 <br /> Name: Wl &igr Title: ffl t r r^- Signature: ate <br /> Y/Wi/###Yifitiis+ssssfif WlW4iW/rti#♦ixissii#WW#iM#iMY#iff Yf sitifWWWWWWW4Y}Y##IIIb W/f4##Yfsssii Yirti##}ilii• <br /> EH 23 046 (Revised 08/13199) Page 10 <br />