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1.01 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> rti*##*iiit**iiiisit*iii#iirtis#*#***iii*###**ti#ii#+*i+iitort++irtiii*iiiiirt#ii*ttti#*##+++#*iisit##sii*++*#+ <br /> SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affued <br /> with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: NPjgnrk Rip... <br /> FACILITY ADDRESS: 800 West Church Street, Stockton, CA 95203 <br /> TANK ID //39 -TANK SIZE: 210,000 gal.pREVI0US TANK CONTENTS:Residual fuel Diesel #6 <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: OGISO Environmental <br /> Address: 1504 Franklin Street, suite 304 City: Oakland Zip: 94616 <br /> Phone N: ( 510 ) 451-5771 Date Tank Removed: <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": Same as section 2 <br /> Tank Decontamination Contractor: OGIRO FnyirnnmPntal <br /> Address: 1504 Franklin Street, Suite 304 City: Oakland Zip: 94616 <br /> Phone q: ( 510 ) 451-5771 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Title: Signature: Date <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: <br /> Address: City: Zip: <br /> Phone N: ( ) <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />