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r y 12-03-1999 12:22PM FROM SEMCO - TO / 4bd.D4�. r.nv l <br /> SAN JOAQUU4 COUNTY PUBLIC HEALTH SF1t4W <br /> ENvIRoMmwTAL HEALTH DVMON <br /> UNDERGROUND STORAGE TANK DLVOSM014 TRACKVG RECORD <br /> rgrwrMrraaagwr+rrArrt.argrRrr.rsa.argwarrr+r.rrrr�rrartlagagq.*rq'Maaar�� alk ���r.r <br /> SECTION ! -Public Health Services <br /> wiPnviroomeatt Health Division Tads Tracking Shat shall accompany <br /> th iu site kk3ldfication number. The Tmk TrukWg Sheet is to be rammed w public Health Services Environmental Hedtb <br />! Division within 30 days of aoceptaaoe of the uok by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and teauned. <br /> PACU] f NAME: <br /> PAcuiry ADDRESS' <br /> TANK ID#39.1.401-OP—TANK,SIZE: PRMOUS TANK CONTENTS: <br /> #wgrrr.�.+Mra.rrw.aalarrrgarrr.rq.ar..*arrq..w.arrraaaraN+a.aw.rrwrrrarrrrr+w+rr.r+rrr <br /> SECTION 2-To be oiled out by tank removal coutr 2cter: <br /> Tank Removal Ctmrrauor. SfS1W <br /> Ad&w; 1217 S. 7th St. City: ZIP: 95351 <br /> ?bone/: ( 209, 524-9653 Data Tank Removed: <br /> .+rr+arrgw.+rover.aar.Arrrrr.aaggr+rrr.aa..wrwrr.ratltlrwrrrr..arrww+rrrrgra.tl+wwwgr.wrga. <br /> SECTION 3 -To be filled out by watradoc"decontaminating tank": <br /> Tank Decontamination Conwaacr. SIIKOO <br /> Amrau 1217 S. 7th St. City: Modesto Zip: 95351 <br /> phone I: ( Z09 ) 524-9653 <br /> Augwdzed mpresenunve of contactor vvrOiag through sigaatose below that the tank been deronunnnu red in an approved <br /> mtam4t as Rquired by Cal EPA. <br /> ' QGGi �(ClCtitn rola ,AA . stgoaaae: Dace l�'12-�Ig <br /> Name: <br /> ahr.wrrrraarrq..a..rMMMaq/r.grrrraiYarrgrrr►##r+11r..r#rawarral...garHr..rr.rrira.rrrMaf.r. <br /> SECTION 4-To be sighed amd dated by an authorized representative of the MUneat.storage.or dispossi facility <br /> accepting tank a &Or piping. <br /> PaWity Name: Modesto JW& <br /> may: 1403 9th Street City: Modesto Zip: 95354 <br /> Phone f: 209 y 522-1435 <br /> Due Tank Rmdved: <br /> Nam Tuk: yAkot _ : Due <br /> gagrawgr.r+.a...rgq�atlrargaM.Hr.MFrgrtlgrfrarMwa+q.rYarrtlwaNwgrp.aaarrr+rrw <br /> EH 23 046 (Reused 9ill/W Page l0 <br /> TOTAL P.04 <br />