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_ fp <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> 4riFF#!rF►r}flr++►lF4f►f}!}r4#+fir}+Ff♦4►fffr}}f}}!}+►!}►f►4}}lFrf►r4fl►f►f►if►fffffffffflfffffffffffffffff <br /> SECTION I - 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 /> FACILrrY NAME: Panella Trucking, Inc. E.P.A. # CAL 000057083 <br /> FACILITY ADDRESS: 5000 E. Frernont St. , Stockton, CA 95215 <br /> TANK ID #39 - 3 TANK SIZE: 12,000 gal. PREVIOUS TANK CONTENTS: diesel fuel <br /> Fr+i+iii}#ff+##Frrr#4►•!rr♦r•fF♦4i#rrtrfrtf4rt+f4F}4#++rr4r♦fff4fffirrrrff+r►}}ff•fffHf►•fflfHiff}fffffif►l► <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe 011, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone N: ( 20_) 368-6175 Date Tank Removed: <br /> if+iFfii4ff}+##}fffi}fflrfFfrtlrt}fffffrt#rtfifffrt4rtrtrr•/•i!♦r#rt}rtr+f!!}fffrt}♦♦F!4}+}f}►!r!4}f4fffrffff►ff}fff■ <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 #: ( 209 ) 368-6175 <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:�M J-AWPe- Title: (/P Signamre: Date�� <br /> iii##art#a+affaf+s+rrrrfff!#fffff!!}r♦4fr•frfff!!•frFrf4}►f►Nff!lffff►flrMf►fffffffff►fHflfffffffffffffH <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facWty <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/: ( 888 ) 866-8265 <br /> Date Tank R ved: ` <br /> Name: Title: Signamr : Date oZ/ AR <br /> lrr4+. rF4f•►►►►r�}!!f!r►f!4!r}ffrff!}}!}}+f}rich+4ffff•f♦rf#}rr4f►flrrff!!!►+•}f+►►Mgffffff►►ifFffffff <br /> EH 23 046 (Revised 9/11/96) Page 10 <br /> - i. <br />