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SAN J .QUI4N COUNTY PUBLIC HEALTH SER' dS <br /> ESI'tRON"MENTAL HEALTH DIVISION <br /> UNDERGROUND�, JRAGE TANK DISPOSITION TRACKING CORD <br /> .................................................«.................«............w.......................... <br /> SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank atfuted with <br /> us site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> Jms form is completed and returned. <br /> FACILITY NAME: A. Teichert & Son, Inc. <br /> FACILITY ADDRESS: 103 North E Street Stockton, CA 95205 <br /> TANK ID #39 - 1555-08 TANK SIZE: 12, 000 PREVIOUS TANK CONTENTS: Diesel&Unleaded <br /> .................:.....w.................r.........«..«rw.r...rw........................................... <br /> SECTION 2 - To be filled out by tank removal contractor. <br /> Tank Removal Contractor: Town & Country <br /> Address: 3373 Luyung Drive Ciry: Rancho Zip: 95742 <br /> Cordova <br /> Phone 4- ( 916 ) 636-9500 Date Tank Removed: March 23 , 1999 <br /> ........................................................................................................... <br /> SECTION 3 To be filled out by contractor "decontaminating tank": <br /> iirfk Decontamination Contractor: Philip Services Corp. <br /> Address. 395 West Channel Road CiryBenicia Zip: 94510 <br /> ?`.tone X: ( 707 ) 746-8287 <br /> Authorized ,-epresemadve of contractor certifying through signature below that the tank has been decontaminated m an approved <br /> manner as required by CalEPA. n <br /> Name6; Eo96V- � t//x!0AJ Title: VteE -r `+tOE/°r Signature: Date � !? <br /> ........... r..u................w.. ...............................w.rr..rr.. <br /> SECTION 3 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accenting tank and/or piping. <br /> Facility Name: Triangle Inc. Of Sacramento <br /> Address: 3525 52nd Avenue Ciry: Sacramento Zip: 95823 <br /> Phone q: ( 916 421-1990 <br /> Date Tank Received: March 23 1999 G <br /> game Nick Chronis Tide: President sign Date 3 - <br /> ..........................,.............................................................................. <br /> FH __ )4h Revised tO/19i98) Page 10 <br />