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r: <br />I <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />*********************************************************************************************************** <br />SECTION 1- SIC Environmental Health Departments Tank Trading Sheet shall accompany each tank affixed with its site <br />identification The Tank Tracking Sheet is to be returned to the Environmental Health Department ' 30 days of <br />acceptance of the tank by the disposal or recycling facility. The permIct holder is responsible for ensuring that this form is completed <br />and returned <br />FACILITY NAME: <br />P <br />FACILITY ADDRESS:_ <br />TANK ID #39 - RICIP <br />TANK SIZE: A/ PREVIOUS TANK CONTENTS: <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor rd 1?!J I'l��® I �� e <br />ss: 70%e_o city - <br />zip. <br />1.3 <br />Phone k of s? 3 J - : __ Date Tank Removed: <br />SECTION 3 - To be filled out by contractor " decontaminating tank': <br />Tank Decor .m Contractor' <br />Address: <br />Phone #: ( <br />City Zip:_ . <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br />manner as required. by Cal EPA. <br />Name: Title: <br />Signature: <br />SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />acccep�ting tank and/or piping. <br />Facility Name l �/ 1� r 9 <br />-- -- `) r� <br />Address:_ '� �/lC��'°� City 114.cc� Zip: — <br />Phone#: &/„/® /a <br />Name: Title: Si Date <br />EH 23 046- <br />