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09/2000 11: 45 20946711-.8 AGE STOCKTON PAGE 02/02 <br /> SAN JOAQUIN COUNTY FMLIC HEALTH SF vICFS <br /> EIWIRONMENTAL HEALTH D>( MON <br /> UNDERGROUM STORAGE TANK DISPOSITION TRACIM0 IiECoRU <br /> ++W Ww#��WMWwn+++�ryrwsk#wwwr*wwswww+sswrsrrrsw*rt►rt**Ms�w+�a*M*rt,�rt*#rMrrwr«�Yw�F+wN�+�M,lr�rt*»Mr*�,4rrrwWsi�rrws*srrsr+rr <br /> SECTION I - Public Health Services Envirommatal Health Division Tank Traeldng Shoet shall smmpany h tank affued <br /> with its site idebtificatioum=ber. The Tack Tracking Shoat is to be returned to Public fialtll SeMebt Environmental Health <br /> Division within 30 dares of acceptattaa of the tank by the disp*M Or recycling facility. The permit holder It trspOnsible for <br /> enet hng [hat this form is completed and returned. <br /> FACILITY NAME: Martini Automotive <br /> FACILITY ADDRESS. 40.32 N E1 Dorada Street <br /> TANK ID 139 - TANK SIZE: 550 gal 1OrtPREvIIOUS TANK CONTENTS: s e QjIs <br /> SECTION 2 - To be filled out by tarok ramov&I contractor; <br /> Tmk Rema4al Conu=an. Advanced a Environ <br /> Address: 4005 North Wilson way City: Stockton Zip. 95205 <br /> Phone#: ( 209 1 4 6 7—1 0 0 6 Date Tank Removed.• <br /> M+�b+kr»ww�NrwNi»W�grMwrMMN�w�Mwi#*�Iw+Wssrewwss*rt�witM r#N»»r+k r#w*tws�w#ss*�*���y�Mr�N+P»*»rMr+lr»�F4ii+4#�+k#*fir+***rte#+��rw� <br /> SECTION 3 - To be filled out by contractor "decontaminating tam <br /> Tank Decontamination Contractor:_"vAne,*#r3 rAn <br /> Address- 4005 N Wilson WAy city: Xtocktan Zip: 95245 <br /> PhoneN: Z[,�09 <br /> Authorized repre=MdVe of oonr ctor certifying through signature below that the tank has been decontaminated in an approved <br /> tr►ttnner ss requited by Cal EPA. .� <br /> L 4 r <br /> Name- � Af Title: Sigttstttre• ""'t"'aCJ Date — <br /> w**r#»*»»err*»»»r»»wr»r»*#tw�lcd�t»***A»»»rwr+4�h�M**k»Assrr»*w**#wwwi»»rrs�*wr+rW***»f�►*wr*wrtrarssrr�r+k#*s#*#Mrtr»»r <br /> SECTION 4 - To be siped and dared by in autharixed representative of the treamxmt,.stoarage. dX dispoW facoity <br /> awq ting Unk and/or piping. <br /> FacilityNamc: West Coast Equipment <br /> Addraat: <br /> 5100 TWOr COurt City: Turlock of Zip: 95381 <br /> phone jy: Z( 0! _) 668-937$ <br /> Date Taal-Amelved• <br /> U 04 <br /> *rrwrwrrrt*r*w+r»rrrwww�.sw#r+.►+»»+�+�wa�*err*wMwwrr�ww+srwsw�**»w**•wr++srw�rww+wr**�.�rt»x�**»yr�rtsw..ssrt«**ry,�,�,�,w <br /> EH 23 D46 (Revised 9111196) Pae 10 <br />