Laserfiche WebLink
06/02/2005 10:22 FAX 510 614 8396 PARADISO MECHANICAL 0003 <br /> 05/31/2006 09:14 FAX 510 614 8 PARADISO MECHANICAL lih 006 <br /> SAN JOAQUIN COU TY <br /> ENVIRONMENTAL HEALTH DEPART1Ml$NT <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> s�*rrr■*iirrir*M*rrrrsrw*** rart*s*sssrritt**ssssstitr*s*rssstss■sss•*•s*go <br /> ■■rrrrsiMrrrsr <br /> SECTION 1-SJC EIIviKonmoatal Hadh Dvpermem's Task.Tracking Sheet shall accompany each tank affbwd with h3 site <br /> kieatificstion number. The Tank Tracidng Sheet is to be mesad to the Envlron RTW Hann Dq to a within 30 days Of <br /> &C,Wptance of the tank by the disposal or recycling facility. Ilse permit holder is tespmible for ensuring that this farm is completed <br /> and mam2cd- <br /> FACII1W NAME- K e' <br /> FACIL.f' Y ADDRESS: t <br /> a.wGruelcd <br /> TANK W#39 436 11 - irk TANK SIZE: / PREVIOUS TANK CONTENTS: *� <br /> r•*rrswr*srrr� it � *���•�■■rsrrF�+srrsssss+strtrrsrsss++*;sssrsrsss+tGood[ *sr�`t*+srrs■ss <br /> SECTION 2-To be filled out by tack r moval coatrxcto� D"G <br /> Tank Removal Contraetm � r I s rit4 <br /> AddnsS:_'L(Aob -Aj)4 .iAMs_ xT —Citi zip: f (677 <br /> Phone#: l a (11 L4-9 Z5 O Date Tank Removed: <br /> .*■s*sss*ss•s+sra++sessss+r+•+••r•ssrrrrsrrssr*ssssrssr#ssrrrssss+sssrrsssf}+stwss ssr*■•sssrr■■*rrrrrrsrrr <br /> a"ON 3-To be filled out by contractor"decontaminating tank": <br /> Tasrlc Decontantinaaoa Cantracwr. DA M 5 d, 11 GS li�C� p <br /> Address: o(o �r nlARfk /o City:�'F/���r(� Zip: <br /> AUMUMind reprrsWbWve of Cotttra=cer yioag through sipabme below that the tank has been teminated in an approved <br /> Mannar as required by Cal EPA D <br /> Name: �t Title: -s'gt�e: me <br /> *ssssf*s+tssrsssss+i*+issrsss##sss•rsss*ssasrssr*ksrsssssssssir sssr+rrssrrsrss•srrr�srr*trrr■ssrs*rrsrrr <br /> SECTION 4-To be signed and dated by an authorized representative of the treatrneal,stoke,or disposal facility <br /> facility <br /> tank and/or piping. <br /> Facility Name•res � &A L) � I]Ll"- <br /> Adds: / <br /> �Q f V�C6 &AD Zip: 5' <br /> Date Tank Received: .3 <br /> Name: Lr2 Title:_ ��15e�...----- Sal ' <br /> ■�.■srrsrtruurrrrs*rrr*rrr•*r*ir4rrrs•sr*.is*iy**r**s*rr*** sr»+frarrrsstr*s*sssssssss�**sssrsrst#ssrr <br /> EH 23 046 (Revised 10/16/03) Page 10 <br />