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12:18/98 FRI 09:33 FAd 5106096304 RHI. DESIGN GROUP +-.+ RHI. PETALUMA 4011 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONKMAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACING RECORD <br />.-. rri.lrr+rrrrt+�+rtwwwwrtwawrr+rr+ war+u+�Yr+ut+rtrwrw+ws++ws*f+wYrr+.rrtweM+a+aYww+row+++r+rt <br />SECTION 1 - Public Health Se -vices Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed wish <br />Lm site idmficaaon number. The Tank Tracking Skeet is to be retuned m Public Health Services Environmental Health Division <br />within 30 lova of acceptance of the tank by the disposal or recycling facility. The permit holder is re_sponskde for ensuring that <br />this form is completed and returned. <br />FACIL= NAME: �o g2 l7 SlI e l 1 <br />FACILM ADDRESS: 1511 F_. oxa'A ee Wdt <br />TANK ID #39 • ()9 � ]—TANK SIZE. 10, OCrD PREVIOUS T-1NK CONTENTS: GAS061P E <br />}wf WYWM�F+iwF+Yrtp+Kw�/Mp�111kFMY�FI�+ICY�MMwtYM►rtwriw+w+PW�M+Wi�Mw�M#TRwO#r�Y+ifi�bY <br />SECTION 2 - To be filled out by rank removal tvmraetor: <br />Tank RemovalConrractor: k.E CurArtS C0115-t-R"+con <br />Address: NOD OL -D Cpr+e�o F-0 city: tau . ip: 61320 <br />Date Tank Removed:_ <br />Ywwr+rrt/�RYrtMr�I�X�R�Frry��YrrtY�+�MYW rye+#�i�Frt#�F4+>rtYiF�F+r+++w�+W r+F�irti�+pwi�F'wF�M�Y++�kM��Y�FW �Mrt�Y�M/uY�FF#+i�FrY+w+�fTrti <br />SECTION 3 - To be filled out by contractor "decontamhmdng tank": <br />Tank Decontamination Contractor. CC05%, overA-0^ <br />Address: bg3D NM4Lktq Sr City: Octkl4no Zip: '7Lbe21 <br />Pt>pue 1E: ( S 1t ) 403'3. 033t0 <br />Authorized representative of contractor cmmffmg through signature below that the tank has been decontammated in an approved <br />manner as required by Cal EPA. <br />SECTION 9 - To be signed and dated by an aathorked mWesentaive of the treatment, storage, or disposal facility <br />a=xmiug malt and/or uiruna. <br />Facility Name: C�D.yI <br />Address: ZL// City: h 7 /'�d�/7>` eZip: �y <br />EH 23 046 (Revised 10119198) <br />Page IO JUL 0 7 1999 <br />ENVIRONMENTAL HEALTH <br />PERMIT I SERVICES <br />