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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> ith its site identification number. The Tank Tracking Sheet Is to be returned to Public Health Services Environmental Health <br /> )ivision within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> nsuring that this form is completed and returned. <br /> ACILITY NAME: LA FINCH PARTNERSHIP NO. 1 <br /> ACILITY ADDRESS: 1611 S. AIRPORT WAY,STOCKTON,CA 95206 <br /> 1 !00 GALCEST�vIOUS TANK CONTENTS: <br /> 'ANK ID X39 - TANK SIZE. <br /> .rrirrrriirr#r#�iiirri�rii'#i#�iiirri+iiitriir#rill+#i+#Y#tr#ir++iiiir#trri#riitiiiiiiitrit#iirtiiiii#ttttrriiit <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> "ank Removal Contractor: JAMES J. HOBLITZELL <br /> address: <br /> BOX 30331 City: STOCKTON,CA Zip: 95213 <br /> 'hone X: ( 209 ) 943 7793 Date Tank Removed: <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 X: (_) <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner. <br /> Title: Signa Z oZ� <br /> Name: <br /> �rr+rirriiri+YYitiiirriiriiii+iiiiiiiYiii+Yiiiiti##iiititti+#i#tittYYYii#ritrrii#itt Yt#titi#iiitrYtiYYiti <br /> SECTION 4 - To be signed and dazed 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: <br /> BOX 2368 City; TURLOCK,CA _Zip: 95381 <br /> Phone X: ( 209 ) 668 9378 <br /> Date Tank Received: <br /> Name: _. Pi <br /> itle: <, Signature: /�fCDau 1 . k <br /> EH 23 046 (Revised 9/11/96) Page 10 / <br />