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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />••••••••.••••••.••••••.•..•.•.•.•.•.•.•.••.••••.•..•••..••••.•.••••.••.•.••••.•. •..•••••.••• <br />SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with its site idenlifleatlon.•••.•••••number•u.•. <br />The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br />recycling facWty. The permit holder is responsible for ensuring that this form is completed and returned. <br />FACIl.rN NAME: Airport Passenger Inc. <br />FACILITYADDRESS: 2305 S. Airport Way, Stockton, CA <br />TANKID#39- TankD"criptioac2-('00 cal' -n gasoline tank <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tads Removal Contractor: Paydirt Excavating Co. Inc <br />Address: 269 Oregon ST City: Ripon yip: 95366 <br />Phony r: 0209 599-2347 Date Tank Removed: <br />...••.•...•..•....................•.•.•.•...•.•..................................................•...•..•.. <br />SECTION 3 • To be filled out by contractor 'decontaminating tank*: <br />Tank Deconam)naUon Conuactor. Paydirt Excavating Co. Inc. <br />Addreu• 269 Oregon St City: Ripon Zip: 95366 <br />Pbone #:( 209 599-2347 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as required by Cal EPA <br />Signature: <br />Title: <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: Cal -Coast Mfg. <br />AddmL. 1540 Lynwood City. Turlcok Zip: 95381 <br />Phone #:( ) 209 668-9382 <br />Date Tank Received: <br />Signature: <br />Title: <br />Ea 23 049 (awtaad 7-10.92) ha• 10 <br />