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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENMONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> mala+alffrrfraal+!lrrfrfrr+frrff!lffllffrlr+♦+rrfr+►♦+wrfrr4rrfr+fl+iff4►•f►►►lf►q►►►44•►4►1►►►►4484►►► <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: Panella Trucking, Inc. E.P.A. 11 CAL 000057083 <br /> FACILITY ADDRESS: 5000 E. Fremont St. , Stockton, CA 95215 <br /> TANK ID X39 - 15S3 -o Z TANK SIZE: 12,000 gal. PREVIOUS TANK CONTENTS: diesel fuel <br /> +#f«+i#i+r#r#rrrflrr+♦+rrrr•♦frrrlf!♦+rl+air•ra++#f!4♦rrfr+l♦tll4+llffllf►rrffff►►4►4448144►►+►►►►f►44444f <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 city: Lodi�, /CA Zip: 95241-0357 <br /> Phone N: ( 20Q_) 368-6175 Date Tank Removed: <br /> ♦++++♦rf4!!rf#4+!«lrfarlrfafl+lfffr«r+frrrr♦fff!!♦f!♦rf!!f!l!!!rf!!fllllfffr•r►►►r►rff4l►►►►f►►►►►/♦►4►44rf <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br /> Phone P ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner asyrequired by Cal EPA. <br /> Name: ttl412-tlK) '�/ll/rp(Sitle: ()00 Signature: / U Date <br /> ++++r♦+rftrrlr#+ar+ar!!!!flrfrrff+##rRfff4rMfrrrrfpr!!f♦!♦lr►pl►rftrf+►►►•q►►1►+•►+•►/•MfIM►►•4►►►1►► <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: West Coast Equipment <br /> Address: P.O, Box 2368 City: Turlock, CA Zip: 95381 <br /> Phone N: ( 888 ) 866-8265 <br /> Date Tank Rei ed: �� <br /> Name: Title: Signam Date <br /> friar#!+ rragarffflf++•K4il+♦!♦!fill+++•rfifffl►♦+lffll4flffrrp#lrfffl►f►fi��►►►►►+►►►►fqf►•b►►r►►►► <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />