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11/03/2006 09:24 4855497 <br />OCS INC <br />G <br />PAGE 02 <br />uce uo ue utdt b98 -•_-n i< tn6ineering 8108423760 12.8 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 4d8-3420 Fax: (209) 468-3433 <br />Ur,,DERCR6l1ND STORAGM TANK DISp YMON TRACKING RECORD <br />Yf YYMYYIf VYMfIII.Yf..........YYwlIYYYlf\T...........Y.lYY!!e/!!\IYYf YYlfllfYRi.lflfflYlf Yf lwl.'>iV-4YYflTwYfi <br />SECTION a - �Jt. kAviwMne 9jal Health Departmmt,a •I•aNe'IiaeNng Sheet spall accompany each tank atGxed with in site <br />iewification numbs. Tbo Tank Trading Sheat if to he returned to the Environmental .Hulth Depafttneol gjtbin 30 dnva of <br />acceptance of the teak by the disposal a recycling facility. The permit beMaf is mqp tole for craur. nr. Ibot This ferm is <br />completed and tetmmtd. <br />FACILr Y NAME: <br />FACILITY n nORMS:- 47 p }11Ci��5T »�LTr C A <br />TAN ID k39 •JyR I S �T.1brlc SlM 00 n-vlovs ra.Nx CONTUS-rs. (:Sn- Cbl t v. o , <br />........ f.......... i.......r.,....en.n-wr...............................>.w.. l..wlnf.w...Y..Yw.f.......w>. <br />SECTION I - To be filled cut by innk reemeva) c mre.tar <br />Tack RGin9val Cornmctor; _M-1TO6 GP tM <br />Addsraa: Z5,ZoQ �„pafll)<1= ASE _ Ciq:Slrli C. VT. zip: �16062� <br />PhoOe�:(P�31 1 <br />--&-, '10 naromeekR.croa•ed <br />.......... >.......... ............... .YffY.Y....... p.fYYYwI..N..f.............. <br />SEC77ON 3 -Ta be Plied out by tnntrattor "decontaminafnte tawk J� <br />r3q TaeR Daeonuminotion Contractor. L. d6 W iSE lVan n nt 6E4J t e4E. t LauG . <br />Address: '575G al wQicS iW� Cib: Cpw�.sp 7�:�3T22•k141q <br />Authorlud ropmarntadve otaantneUr eerti$ting rludu$lr figtutrac belo.'sbat [IW ik tarn)mtrd in an approved <br />manner as required by Cal LPA: <br />Name!" T, uAaftr.OW4 Tidd: CAwa .41 Date l l.O 'Q <br />..........>......>..o ............ ................ ,........f.... ..:..:..aYw....r4l.ul. \.....>.Yf....:. <br />,V,M,O?f 4 -Te, be allined and dated by gn nuthdriud reprasantotive of the t "Imont 81trbge, o; d6poaal facility <br />aoir;7 l; tank and/or piping. <br />Facility Nwm ��j ,. l �r� r�� <br />Addrac: _� P Atr1-�K– 1_W'0 city. Y ! L�' `� T.tp; <br />"hone a; L5l `ul^.— <br />Date Tank Received: <br />Name:.— <br />ff.vu..r.... f«fY...\l........ !l.r... ..... ru•w•f.•>.Y..Y+wle.................. ........... f............. <br />214 2a 046 (Eewiaed V1W() <br />ld <br />pl•a oscezi.eele auj�gew=aua a d e9l.rtf so TC Aou <br />