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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ♦++++rf#+qq•r!#rqr!!!#rfggq#gram+rrrrr/r+rrllgrgqq+arragrrgr►grrrr►►►ififgpfqfqq►ff►►rf <br /> SEC'T'ION 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 /> FACILI"rY NAME: Panella Trucking, Inc. E.P.A. 11 CAL 000057083 <br /> FACILITY ADDRESS: 5000 E. Fremont St. , Stockton, CA 95215 <br /> TANK ID #39 -/J3 3- o STANK SIZE: 12,000 gal. PREVIOUS TANK CONTENTS: diesel fuel <br /> +++r+++++«rrr#rl#rr«+aggrarqrr+r!«rfq/+#+++rrrf!!r♦rrq•f+ata+rrgrfr+♦♦•ggqrrrf►r►q►r►frgf►ffrfq <br /> SECTION t - 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: X/q <br /> rr+«rragrr rf grrl#r++rsrf#1rrrrrrrr+#+f•rrl##r#q!f ra#rrrrrrrr+•a#frrrf r4 rrrrrgrrgrfrrfqrfff gfffq►fff <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe 011, 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 JEPA. l <br /> Name: IM�tIld V�R17.L Title: Ly�/ t SignatureDate <br /> ++++«++f f+q+#arfa♦f+f gift+qqf##arsfr#ggqf♦#+#q«rf of+#►#rrr+►arrrrggrr►gffr►►►•►►f►fff►fff►ffrfr <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal faculty <br /> accepting tank and/or piping. <br /> Facility Name: West Coast Equipment <br /> i <br /> Address: P.O, Box 2368 City: Turlock, CA Zip, 95381 <br /> Phone N: ( 888 ) 866-8265 <br /> Date Tank R ed: - O <br /> Name: Title: Siguamr . Date <br /> a4r+# q aagfrr�rq##rrrrr►rrr+##+f/ir�lrlagrq#frq rrr Mr\rrrrrrr qtr►#rr►rrrf qtr►►►}rMq►►•►q►rff <br /> EH 23 046 (Revised 9/11/96) Page 10 <br /> I' <br />