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MAR-18-99 THU 05:54 PH P. 03 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL EWALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACIWG RECORD <br /> stc-noN I public Health Services Envimumental Health Division Tank Tracking Shea SWI accompany each tank affixed with <br /> its site identification ouniber. The Tank Tracking S is to be rerurzigd to Public Rath SeMces Enviromnental Health Division <br /> within 30AM of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> this form is completed and murned. <br /> FACILITY NAME: FRI 1A.4 <br /> FACILITY ADDRESS- <br /> TANK ID#39- F 1 TASIZE_ 15,Q&#220 PREVIOUS TANK C0KTBNTS:Kr06 —'ISVWWt6� <br /> Soso— WASM Olt., <br /> SECTION 2 -To be filled out by tank removml contractor: <br /> Tank Removal Contractor: f2S96Q1CV4Af%11CA-1,,-LL6 <br /> Address: City:<ALA Zip: q 4,5 1-7 <br /> PWnc#-, (0.;10 ) 1 O Dam Tank Removed: <br /> .......... <br /> SECTION 3 -To be filled out by contractor"decontaminating tank": <br /> Tank Decoutaminauen Contractor: <br /> Addras; &4&,) AM ELI -410211. City: Zip; <br /> Phone#:( splo <br /> Authorumd mprommve of contractor ccrafying dirough 3ignature below Thu die tank has been demnammated M an approved <br /> manner as required by Cal EPA. <br /> Name- Title- slgwwre: Date- <br /> SECTIO4-To be signed and dated by an autharind rWmatadve of the treatMem, storage,Or disposal facty <br /> accepting tank anW(w piping. <br /> facility Name: a ire <br /> ACity: M&4M0K1rP' <br /> ddress. FACE- &24-2 Zip: <br /> phone <br /> 1: ( <br /> Date Tank Received., <br /> Name Title- Signature: <br /> EH 23 046 (Rovised 10119/98) page 10 <br />