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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />ROUND STORAGE TANK DISPOSITION TRACEING RECORD <br />#rw++lt++++w++twwwswssis+s+lrs#!#!s!#tt+l+l+rt++rt+strt+++itt+rtilslts+!l++rtwlrrtwrt++ttwwiil+++wlrtsi+!!l+rtrt+** <br />SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br />with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br />Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: �P A*I r- (PKO KIZT Y - <br />FACILITY ADDRESS _A&PPO Co,eMt— /1D1L6W Rb - IWACCI . C4 <br />TANK ID #39 - TANK SIZE: fZ,btlC Cft PREVIOUS TANK CONTENTS: &t4s4� I- <br />++i*+wi+wwwiirtiiirtwt++ii++++#rtt+*#+*++w+++w#+++rt+++rt#+trtrtwwwrlrwrsirsrrrwwrlrt+lrilwrlrtr!lits+t#ir#rt##w*r#rtrt <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: S124CO <br />Address: 1217 s. 7th Strut City: Modesto Zip: 95351 <br />Phone p: ( 209 ) 524-9653 Date Tank Removed: <br />!rtr#irwrrrr!lrwst++i#iii++iti##!i►ii#i#ii!#1iiwwlrrirrtirlwirii+*!!t#!!+i!!+tli##rt#!!!+i!*iii+iwiiwwi#rt#rti# <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: SE14CO <br />Address: 1217 S. 7th Street City: Modesto Zip: 95351 <br />Phone p: (_299 524-9653 <br />Authorized representative of contractor certifying through signature below that the tank has been decoutaminated in an approved <br />manner as required by Cal EPA. <br />Name: Tide: Signature: <br />Date <br />SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />Facility Name: Modesto Junk Company <br />Address: 1401 9th Street City: Modesto Zip: 95354 <br />Phone A: ( 209 ) 522-1415 <br />Date Tank Received: <br />Name: <br />Title: Signature: Daze <br />+iiiii+wrrilr+r!!wrlw+lir+rwwww#rrrtrri++wtrtirtsr+rs+!##rtrtrtrtr#srlrt+rttirwsiw!l►►i!lttw+tt+#rrw►!!lrtrtrrrlrt*rr <br />EH 23 046 (Revised 7/10/96) Page 10 <br />