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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACIONG RECORD <br /> tii4i►rtiirtr►4rtr►►i#ii4rti#irtii■i►irtirirt►iiirtyiiiiiiiii►►i►ii#i#i►i#iii##i#i►iii#iii►i##►iii##r#i►ii##ii►iii# <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services!a viron e tal a Healith <br /> or <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The perm Po <br /> si <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: LA FINCH PARTNERSHIP NO. 1 <br /> FACILITY ADDRESS: 1611 S. AIRPORT WAY,STOCKTON,CA 95206 <br /> TANK ID N39 - <br /> TANK SIZE"000 GAL(ESTkEVIOUS TANK CONTENTS: DIESEL <br /> TANK I .D. NUMBER 39-SR-020809 <br /> ttiltrirrrlii►ri►rt/ii►i►ririiii►til►►iirtiirirt+iitirrrrt#iii+iiiiiiiirrirrtiiiitiiitirii+iirt#iii+iiiiiirti► <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> i <br /> Tank Removal Contractor: JAMES J. HOBLITZELL <br /> Address: <br /> BOX 30331 City: STOCKTON,CA Zip: 95213 <br /> Phone A: <br /> 209 943 7793 Date Tank Removed: 21 DECEMBER 1999 <br /> (_� <br /> ttrirtrii►4i►rrt►i►iiiirtt►►+rt►riiirttirti;itrirttii►r►riii#iriirt#i►►iii#iii►#t#4trtrtirtrtirtiiriiirti#rtiiirt►►iiirii+4 <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: <br /> SAME AS SECTION 2 ABOVE <br /> Address: City. Zip: <br /> Phone d: ( ) <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated' an <br /> Address: approved <br /> manner, <br /> Signature: C r 21 ii l/1� <br /> Name: JAMES HOBLITZELI Title: rnNTRnrTna t� <br /> s+i.rrrirtiriir►►+ir+rrrrrirrrritrri►ri►#i►r■►►►rtirii++r+ir+rt►ii►rrrr►tirrii►iririt+rir rt►i lir►rtirrrti►►ir <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 /> WEST COAST EQUIPMENT <br /> BOX 2368 City: TURLOCK,CA Zip: 95381 <br /> Phone p: ( 209 ) 668 9378 q /� <br /> Date Tank Received: t L 1 -/ <br /> 11, 1 )(L ikllfitle DPz i�J Signature Date t <br /> Name: R'z r cc�C <br /> rtrtirrii+rrirrraiiriiiiirrii►rirrrrtr►+r�►+iriii+iirrr+irirrir►ii►cirri►+r#rririrrri+++++i+irir►ry►rrrrr <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />