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11/03/2006 09:24 4855497 OCS INC • PAGE 02 <br /> uee uy ud utls0're ti i! tngineering 8198423760 p. 8 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> sale JOAQUIN COUNTY <br /> yelephoue: (209)468-3420 Fix-.('209)468-3433 <br /> UNDERGROUND STORAOX TANK DISPOSMON TRACKING RECORD <br /> YIYIYYY<Rw<NYA<IIN<\AI YYIf....... R...NYYY\R<I IRNYYIIYYIYYY<RAYYIYY.rRR<YRef<IY<I<Y«Y.Y'1<II.-Y4<Y MRR.Y <br /> SECTION A —W(;Amviremmeawl Hatch UepaAtnm"'l'Qrx'l"wo6'sbeet Shall accompany cacti tank alTumd m1h its sttt <br /> ideoliTealion number. The Took TrackiAa Shea(is to are mturtred to do Envlrotlmmtal 8nith Depw tmt:ot 11t •a 30 dams of <br /> acceptance of the in&by the dis owl or recycling faeltity. The peemp beMar it mtponsible for cosurirr; that this fbrm n <br /> completed and returned. <br /> FACILRY NAME �/b�l E 1Zd <br /> FACRMA"tMrsb: 470 N 1nl 'r!�?nl?rG`•A 'C.1� <br /> TANK lD*"15 UR I S�V'NK 01.T.71D 0 n-wzovs TANK cOWTUS-M <br /> .1.<I<III...........<I.}I</,1<'Ya{II Yw IR..Y..M..\<YN...Ya«Y.....4«.Y V 11<Y 1V I..N YYY<YNT.p................. <br /> SECTION 2.79 bo SUed eat by tank removal eoato.tm: <br /> Tack RGUwvs1 Cvrar+lctor: "1'y_1'('pp�J GP NS� <br /> Addn ;a Z s(oc �O°CL��1—A�6 — Clry:_ t _a V2 zyy: ge'cla-L <br /> Phooe a:r e'51 1 415- Po!41 naro rrck ttaaa ad <br /> .I..N..w<'1Y1\IINN./<........N<fMY1.1M ..V1......<YYYIY<Y..<f.Y-1.,.......t <br /> tiEC770N 3-Te be lllletl ou+by eontraaor"deeenumtnatinp tack^• �� <br /> ...m Tsbk Daeontambtatoa Commctor., Ott.• COW 61t—wrn O N 691R 1 c4, tr'y'. <br /> Address' 32SC u Y liftA -A A'd<_ G1ly: CQsewio 7.ip: ��]ZZ•Q414 <br /> Audroslced mpresemative afoon[near certifying+Hough sijttstum bcloR�shor ;� Zlmillattd in an approved <br /> eeAbeecat required by Cal C•PA: <br /> Notbe:bmYT. IlAarb.banf Tide: Uo 3l are11-02.0............................NN....... a.:vN.wN.Yae. <br /> MMON 4-To be s*,ed and dated by an eatheriW repritsutetive of die bca(m m dotage,or dkposal racility <br /> octtptlng lank andlorpiping. <br /> Facility Warm Cr <br /> Addrnfo� 2 3�i C'$R��.)� ct�:rllckl VY_L�►J[� zep; ri.'-1 8� I <br /> Fbode o:L51tD) 235 - 13�� ^.— <br /> Dale Tank Received; <br /> Name:_ Ynle• Sig..fturr DYm <br /> ..ISRI YY'IM.u.}w*YwYYNNYYw.OAYYAYY Y V<HYN.Y.M?Y MY Y.<\IHN IM!N.INY...R If<Y...<Yv..YY1 Yf N.eH. <br /> E142.1046 (k"ised VOM) ]d <br /> 01 '01 096E66BBt9 8ul.aomus8ug Ig H egycTT so TO A0W <br />