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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> #++#r>!!+►rrrr\►\\►rr►rr►rr\rr+>++rrrrr+#r}}rr\r•+rrr!l►►►♦rr►+r►rwrr►r►►►r►rrrr►rrr►►►►r►►►►rrrrr►rr►►►r■ <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 Envirommental 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 retumed. <br /> FACILITY NAME: Panella Trucking, Inc. E.P.A. II CAL 000057083 <br /> FACILITY ADDRESS: 5000 E. Fremont St. , Stockton, CA 95215 <br /> TANK ID N39 6& TANK SIZE: 8,000 gal pREV1OUS TANK CONTENTS: New Motor Oil <br /> ##+++r+>#r44!#>►#!4+#irrr#>\\•f•r+}###W#►f4r>4!\r#►}r►lrf►rt>#Orr#f\♦r►\►!}}►rrr#r►►►►►r►►►►♦r►r/►r►Miff►r4► <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, CAG Zip: 95241-0357 <br /> Phone N: ( 209) 368-6175 Date Tank Removed: �{ / <br /> \f«##!tr#!\Wflrr!♦}#}»}r!f\>T#»>r}#rW#!4#>}4#!##!#WWW#\•lfWFrWf\r!r!!►•>!W►\\►►r4rr►r►►\►►r►►r►►►►►►►/►►/► <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: Lodir 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. C J / <br /> Name: (YLQRIT►� (Lp� Title:_ (�� Signature:/ 64;6 —/G`e Date 2the <br /> «+#+++>+4►+##+»rrr:>4»r:►f+►r4}r#f>r.4r»\rf\.!!.}f+#r#r•>rr►4►r}r4•rrrr#r►►4rp#►►rrr►rr►►rrrr►►►►►►►►►rrr <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 ived: V, ' <br /> Name: 4& itle: Signature Date <br /> r>#+r»♦r!+#r►►rrrir#rrrfafrrrrr>#+>r#r4>rrrr\!rr}►»!►r!#r+\rrrrr>rl4►►►►♦ r►►rr+rrrr►►r►►rgr►r►rr►►r►►► <br /> EH 23 046 (Revised 9/11/96) Page 10 <br /> I. <br />