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SAN J(*UIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRCNNIENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br />its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br />within 30 days 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 returned. <br />FACILITY <br />FACILITY <br />TANK ID #39 - <br />CAPITOL AUTO SALES <br />650 E. MINER, AVENUE, STOCKTON, CA 95202 <br />TANK SIZE: EST . 1, 0 0 0 AVIOUS TANK CONTENTS: GASOLINE <br />SECTION 2 - 'ro be filled out by tank removal contractor: <br />Tank Removal Contractor <br />Address: <br />JIM HOBLITZELI <br />BOX 30331 <br />Phone N: ( 209 943 7793 Late Tank Removed: <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />JIM HOBLITZELL <br />Tank Decontamination Contractor: <br />Address: B O X 3 0 3 3 1 <br />Phone N: ( 209 ) 943 7793 <br />City: STOCKTON,CA Zip: 95213 <br />City: STOCKTON. CA Zip: g5913 <br />Authorized representative of contractor certifying cbnugh signature below that the tank has been decontaminated in an approved <br />manner as required by Cal EPA. <br />Title: Signature: <br />SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, it disposal facility <br />accepting tank and/or piping. <br />Facility Name: WEST COAST EQUIPMENT <br />BOX 2368 <br />Address <br />Phone b:( 209 ) 668 9378 <br />Date Tank Received: <br />Name: <br />City: TURLOCK, CA Zip: <br />95381 <br />Signature: _Date <br />EH 23 046 (Revised 10/19/98) Page 10 <br />