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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> #t##rt####tw#*tii+#w##4w#iwiiti###w*+ri+##rrt###+#i#t#wi##twi##i###ii#twi###wi#ttw##tw+t#i#t+#twi#tww+#+tiwi# <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 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: LA FINCA PARTNERSHIP NO. 1 <br /> FACILITY ADDRESS: 1611 S. AIRPORT WAY,STOCKTON,CA 95206 <br /> TANK ID //39 - TANK SIZE1,000 GAL(ESTpREVIOUS TANK CONTENTS: DIESEL <br /> ri#wwr#*++**trr##tirt*wi+twr#+ritww##wr##wiitri*tww:iw+i*rw+rt+riiw##*r*#wr#+#tw*+r+*t**+tt+*t#++t#i*##rrirt## <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JAMES J. HOBLITZELL <br /> Address: BOX 30331 City: STOCKTON,CA Zip: 95213 <br /> Phone N: ( 209 ) 943 7793 Date Tank Removed: <br /> *#rtti##tri##wi*twire#ii+wirttii*tiltii*twwiit*###w##tww*twww*ttwi##tr#*##ii*#+i#tww*#w+#twi*#ti*+t**si*rii# <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: SAME AS SECTION 2 ABOVE <br /> Address: City: Zip: <br /> Phone p: ( ) <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: <br /> Title: Signature: Date <br /> ##rt#r#*#triiwrii#rii#tii#tii#ti++tii#rw#trww+ii###w##t####ti##wwwi####w#+ti##wi####*tiitw+#wi#t#wi#iwwi+### <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: WEST COAST EQUIPMENT <br /> Address: BOX 2368 City: TURLOCK,CA Zip: 95381 <br /> Phone N: ( 209 ) 668 9378 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />