Laserfiche WebLink
08/29/2003 FRI 05:49 FAX 661 393 3834 MP ENVIRONMENTAL-BAK a 005/006 <br /> May-22. 2003 4:11PM Glap: ,r Environmental 0 No.0354 P. 12 <br /> SAN JOAQUJN COUNTY P=C WALTH 89RVICFS <br /> ENVIRONMENTAL IMAL=]DIMON <br /> UNDERGROWD STORAGE TANK DISPOSMON WRACKING RECORD <br /> rrrrr.r,«r*rrrrr«��•vs!*r+swrw�ttrre**rwrrr«re.wwlrrw«.rr■rM«mwrrrrr«rrrr«wr*etr#rttrs.NrtR,�rlrrrr+rra�ewr. <br /> S1~CnON 1-Public Health services Environmental Health Divislou Tank Traeidug Sheet shall aaeeatpamrw <br /> eaC�tAnlc aPftxrd ith <br /> lta site idendfltxtfon cumber. The Tank Trackiog Sheet is to be returned to Public RemSemift4 W Health bled g <br /> within 38 dare of=aPtamo of the rank by the disposal or recycling facility. The perodt holder is resporwtble for ensuing that <br /> Us form is cwarilaW ko retucacd. <br /> FACILITY NAME: <br /> FACILITY ADDRESS• z 3(a*%p k <br /> TANK 10,f39- —45'611S!' ANK SIZE:_ U�,oa r1 PREVIOUS TANK CONTENTS: <br /> r.rrrrrrart4�+#r«rrr«rrrrrr*rrwww+ewrry�Ywr«rrawwrwrrrrrp;*a+#r+rr+*rrrrrrraprr*bM4rrrwrs�ewwr #rr++wsr�i*!rr►�x <br /> SECTION 2-To be filled nut by Wk remoras conaraetar; <br /> Tank Rt tnovat Contractor; I ,r -L, <br /> Address: q61(La 1�. i'y E t 1 ►�S.. C� eA 4 Ci � j e. ' <br /> tYt f'1-�/ tu A ZIP;_,.SaVI �' 75— <br /> Phouo Due Tu&Romoved: 6 <br /> !�l�F+!l+4aKe!llrrr#y+ttrrA•rk�rrit«rr.rifl+rvw+kwr+Yrrr«Twit«««rrrr+Fww*r*rrr*d,Orr«wwrrrrrwwwwrrrMrrrrrr®*#r.ea <br /> SEMON 3-T,p be SW out by contmaw"dococtaasiaating teak": <br /> Tick Deconuninaft Contractor. f�.1 J A ram+ Mv.KJ-c. .l <br /> Addren: f.•c;. Ciry: t';c k+..a f 1 Zlp: 933 04� <br /> Photo o — / 5 f <br /> Authorized reprasa mdse d ootitractar certiCyirtig through 61guattn below that the tank hen beat deeoumL-g d in an VprovW <br /> mznaer as requited by Cal EPA. <br /> Nmae:, UES OSR A N 0077ti 7-ate: RRps- rn <br /> WrrFrrrw44006*rribr«ra««w«lr40w4A.IM®«t.err,4w«Rrwq•44«ylr�hrrrrrrwww6+rtl.�rp6**A+rrr9rrrrtrrrrpN®itrrtrrttiM4�i4r <br /> SECTION 4-To be signed and dated by an authori2ed repreaeaeative of the ttCRQ=4 storage,at dispow fhc"NW <br /> svccptlrig tatkxnd/or piping, <br /> Pacik Name: G C&D CSV S•'7A-11F <br /> Address_ b'�t�iy� � �.. City_ _ .0 <br /> Date Tank Raodva- <br /> Name. t nlaElk 1 �gm- ilk:_ ��5 Sigaatarr • �j d Gj <br /> .lr4i*!«$wblr!*lrr+!#$$tgl44+9l14�tl4+4yF$!!!l4Trs!«rr«brw4rsrl4�P+*tfl4lm4!!!4!«!M!«!r$rrrq$*�plTelt**!t! <br /> 8K T3 046 (Revised�l'IS/99) Page to <br />