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SEMCO <br /> ,Tames C. Bateman Petroleum Services, Inc. <br /> 1217 South 7th Street, Modesto, CA 95351 <br /> Environmental & General Engineering Contractors <br /> License No. 449864 A, B, C-61/D40 <br /> (209) 524-965 <br /> TANK DISPOSITION TRACKING RECORD <br /> SECTION 1: A Public Health Services Tracking Sheet will accompany each tank affixed with <br /> Ws site identification number. The tracking sheet is to be returned to Public Health Services <br /> within thirty days of acceptance of the tank by the disposal or recycling facility. The permit <br /> holder is responsible for ensuring that this form is completed and returned.. <br /> FACILITY NAME: Nelson Ready Mix Company <br /> FACILITY ADDRESS: 1040 Moffett Blvd. Ripon, CA <br /> TANK ID: <br /> TANK DESCRIPTION: 4,000 gallon diesel tank&associated piping <br /> SECTION 2: To be filled out by tank removal contractor. <br /> TANK REMOVAL-CONTRACTOR: SEMCO - <br /> ADDRESS: 1217 S. 7th Street, Modesto, CA 95351 <br /> PHONE: (209) 524-9653 <br /> DATE TANK REMOVED: �(( f L(�� <br /> SECTION 3: To be filled out by contractor decontaminating tank. <br /> TANK DECONTAMINATION CONTRACTOR: SEMCO <br /> ADDRESS: 1217 S. 7th Street, Modesto, CA 95351 <br /> PHONE. (209) 524-9653 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an proved manner as required by the State Department of Health Services. <br /> SIGNATURE: TITLE: <br /> SECTION 4: To be signed and dated by an authorized representative of the treatment, storage, <br /> or disposal facility accepting tank and/or piping.. <br /> FACILITY NAME: Modesto Junk Company <br /> ADDRESS: 1403 9th St_ Modesto, CA 95354 <br /> PHONE: (209) 522-1435 f <br /> DATE TANK E D: <br /> n <br /> SIGNAT � y�r TITLD: <br />