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ENVIRONMENTAL HEALTH DEPARTMENT SAN JOAQUIN COUNTY Telephone: (209)468-3420 Fax: (209)468-3433 UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD .........»............................................................................................I... SECTION 1 - SJC Environmental Heafth Department's Tank Tracking Sheet shall accompany each tank affixed with Its site identification number. The Tank Tracking Sheet Is to be returned to the Environmental Health Department within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form Is Completed and returned. FACILITY NAME: TEsc>>Zo USA ,orb BfSU FACILITY ADDRESS: /99757 �' Nwy Bg / LOGk EPorzOr CA• 9Cz 3'� TANK ID#39- 3 rAbIKS TANK SIZE: 101000 CAC PREVIOUS TANK CONTENTS: Cf ASnCrNE- SECTION 2-To be filled out by tank removal contractor: Tank Removal Contractor: A''8LC /NA1A1�A&E- �G Address: 3 �-4t �C-�7/ONAC— PkAly City: 6AAlrA P65A zip: R5-4fo3 Phone#:( 07 ) .515- —SS2Z Date Tank Removed: SECTION 3-To be filled out by contractor"decontaminating tank": Tank Decontamination Contractor: A b MS AE/Z V/CF�S • IWC- • Address: 7/,967 c. . At vAIIWA e4CvU Cay: c'yp,�.�.saNA Zip: 91114;/ Phone#: Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA. Name: Title: Signature: Date SECTION 4-To be signed and dated by an authorized representative of the treatment,storage,Or disposal facility accepting tank and/or piping. FacitityName /��/-�/6[/L S ,eV/C,GS _ �/AscU /e0A6 eAn/C> firGG- Address: voq AI. VAsco RoAQ City: 4,V. Ieml:,gepr Clip: �'ySS'✓ Phone#:( �aD ) Locj'_ 5�1z5/2- C/z/ co,✓rAcr— -loc- Cye/Fc)Tjl Date Tank Received: Name: Title: Signature: Date " (pnik `z. EU123046 (Revisedd/I/II) 9