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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> Ftiit+aM+4#4iitt♦i+ii;r###►ilffRif\•f;i!!♦f!\i►f;+f#f!}►f;r;lf\\iffi•}}!►rrrf;►i\«►\}#i}i►►►rrrrrrlrrrrrr«► <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 /> FACILITY NAME: Panella 'Ducking, Inc. E.P.A. # CAL 000057083 <br /> FACILITY ADDRESS: 5000 E. Fremont St. , Stockton, CA 95215 <br /> TANK iD #39 - /s.5.3-0 7 TANK SIZE: 10,000 gal PREVIOUS TANK CONTENTS: unleaded gasoline <br /> ati+++itiri#iii+fiaf\rrffrt##frf«afrriiififf•}#►;#tffrr;;iii+rr#++ir#\prr#;r#;#rrr\;►rr►«\ri#+■«ri►rri\f}r <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 d: ( 209 ) 368-6175 Date Tank Removed: <br /> girrrii}frpiirffrit#rf►rrlriirirlitfaMfi4#4if#+tiiifi#iii#ifrriiii}iifi++rffir•►•!i}tiff\\ii\rr«}►+;+♦•tit <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 /> Phoned: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated is an approved <br /> manner as required by Cal EPA. ��/ <br /> Name: Ts> 1kyt_. Title: Vl io Signature�irw�V//,.n o Date <br /> afiiiiita#+iilfiiiiff+ifrif##!#!♦;ffi\iii##!###!}►T#;f;f!/fritf;fi4i;ff;r##rf#«««««rrrrrr\►\►rrrrrrr►►\irrr► <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 Cin,. Turlock, CA Zip: 96381 <br /> Phone d: ( 888 ) 866-8265' <br /> Date TanZved: <br /> Name: Title: Signature <br /> ail#f#rlrrfir;lrf�r\r\r•\►++f+r\\}f!t#iffrif++#+#r+ir+;.r;if+f♦;;f«#riff►r;#«r«#«rr\\►rrrrr►rrrrr«rrrrrrr <br /> EH 23 046 (Revised 9/11/96) Page 10 <br /> I. <br /> i <br />