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'0 <br /> 06-19-1999 11:23AM FROM acMC-O TD REDWOOD CITY P.01 <br /> E <br /> i - SA JOAU�IN COUM PUBLIC BEALTH SERVICES' <br /> EINVIRONMFUNTAL HEALTH DIVISION j <br /> UNDERGROUND STORAGE TANK DISPOSITION TRAC G RECORD <br /> y <br /> ww*#drdem**+a»ar�*mwwki,k�0ua#ttkw�e*lsapye**sRmwpmwww#*#gyp#pgyew####gyp#,ageqwM+a++Yw##*FIs,syrxawahawrss:#eprmsMw�c****yewww###oxc*.fie*#* <br /> SECTION 1 -IPublic Health Services Enfvitrontaental Health Division Tank Tracking Sheet shalt accompany each tank affixed <br /> with its site ide�dflcationnumber. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division withiiN da-vs of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that tl s form is completed and returned. <br /> FACILITY NAME• VAL LVWS AA_ <br /> � . i <br /> � I <br /> FACILITY ADDRESS: Wt,--0 'k ,° �ialdJ . <br /> TANK ID #39 TANK SIZE;_7,WO rsiA-L PREVIOUS TANK CONTENTS: t ,C L f <br /> SECTI <br /> ON 2 - �,o be filled out by tank removal contractor: <br /> I I <br /> Tank Removal Contractor: SEMCD <br /> Address: 1217 S_ 7th rt-r r City: modesto Zip: 95351 <br /> Phone#: (_209; ) 524--9653 Date Tank Removed: 19-fq-rp4 <br /> I <br /> M*w**+�aww>r*wwv******rwwwrw****•.****x+r##*#**#**�+w#**##.*,x+:«*aww#,rw*:w*##mea+aw#w#s#m..xwww****w##*.w.aw**��.m* <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": f <br /> Tank Decon tion Contractor: 334W <br /> Address: 121i'& 7th Street City: Modesto Zip: 95351 <br /> 4 <br /> Phone#: (__20j_ _} 524-9653 <br /> i <br /> Authorized repr eatative of contractor certifying through signature below that the tank bas been decoutaminated in an approved <br /> manner as requieed by Cal EPA. <br /> Y / <br /> Name: 1 W _ Title: Si t ' ate 6—19 <br /> #}#MMfR#tl[#WMkkN,�#+f#*#'#,R*k+k*+N#F+f�#**#R+1%iNM+FMB#M####*w#kR*WW+k+kwwisnbsa#lca,KwR*#W+kik+k#,k#RF##+FRw*W+R*k*+Mk'wwwMM�'#�#M i <br /> SECMON 4 -To be signed and dated by an authorized representative of the treatment,storage, or disposal facility <br /> aGMting tank and/or piping. <br /> Facility Name: 11joclesto Junk_Cotpanv <br /> Address: 11403 cath_ st,-tet- City: Modesi o Zip: 25354 <br /> Phone#: ( 20i ) 522-3435 <br /> Oita Date TankR i ed: J <br /> Name I Title: Si "` i' Date <br /> wdr+ms+lnF##a##' ##yds#w®+rwwwNNYM+aweh+M#!r#slet#sw+pesquuwwMMrFwMwHrywwk+ktsa#t###r:t+�#asXev+Pawww,Mww#raw+►deer#.s+ifsie**�e�tw#Aw+e <br /> t <br /> f <br /> EH 23 046 (Re{ised 7/10196) Page 10 <br /> i <br /> TOTAL P.01 <br />