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11/03/2006 09:24 4855497 <br />DCS INC <br />lJ <br />PAGE 02 <br />uce uy ue uase'la _ti v tn6eneering 8188423760 P.a <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Pax -,(209)468-3433 <br />UNDERGROUND 9TORAG>t TANK DISPOSITION M%CKING RECORD <br />qat ....................1.T.11 w..........UrIFiaO....A."...wf.ua......agf......... <br />T+R. nl <br />SECTIQN a — JWtr Ynvirt+rurental Hwlth Uepatttnmt's 'Pante 'I-reuavg seat c),all seeotrryaey each tank atfXW with its site <br />idootif,"Ron numbs. The Tank 7rocking Sheet i3 to he mwited to the Envlronmtnial Health DepwTorseet .wk in 30 dnvs of <br />acceptance of the mac by the disposal M recycling facility- The peRrslt keldar is mepensble for cscurirm that ibis Ibtm is <br />completed and cennnee. <br />FACILITY NAME:_ <br />Fm.(,7LTTYADt)RESS;�6:1-0 N N�S'r i•��?N'7r-CA, C' <br />TANK ID k39 �J O 1 `J Z T,% M 57M1t-: 1��_PR`VrOUS TA2: r- CONT6S'79 <br />.fw...a..............1..r..M1/YT�1eY TT w...YT.a..\./.......atf.TY...I.I.I....aa.......P,... o..T......\w....f .+.n.e <br />SECTION t . To bo filled out by tnnk removal wetr.dor: <br />Tank Rcnw•Al Conunctor. Tz rtgr, Go N! r <br />Address: Z�7(pfD Cjp�(11 GL_A�E ,City: _C.�VZ ZID: �i�062-- <br />phoee X: f 23l ,, i}'1 Gi •Pot 4t Darr Tnv1t F. mo.ed <br />.....a...........................................w....-............eel..q.........•. ................ <br />SECTION 3 - To be flled out by coetrattot "dtconHminatio¢ tack"• J <br />.»'�Taeic Dweobtsminotion Coneacter, Oso Caw 66294n DAS 6 Q%JiC4rte• <br />Address: �i256 u, LARKS 00'rCib: 1 �0 7�: q]T22• 9l4 <br />Phu= k' (56 1 ) IIOS- Sdd1 S —..�.. <br />Autlrorizad MptesontaIM of oontractor crnt$ins +luouprlt signature boioa's!sat cix <br />mann"ME required by Gil GPA: <br />NomeALvrLPl. T•: iielaY]wbtpnr <br />in an Approved <br />SBCT[O1e 4 - To be slgned and dated by an authorized of Ot tostrr= mo.ago, o: disposal faciliq <br />awapting ink and(or piping. <br />Facility Name, t,. CT <br />Addr w -15 PAW I`1 \) ctv:l2lcmpwtyy vp: `7q 6c l <br />Phone x: LS 1 S <br />Date Tank Reeeivtd.— <br />Noma: <br />Tift- <br />....r.T.."--s—to TaTY...Y...r.A..T...Y..wa..A...f..••••.•.••••......... r............ a.. <br />Ela V 046 (Reviled WOO,) <br />01'0. <br />ILO <br />oSCEzbBele 9ufaeous9us 6 w <br />16 <br />eSr=tt 5D TC Anu <br />