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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> 1!••.Ittta,ttta,at,at Otlttltttttttalattttttt„ttttt.Ytt.ttttYllttt,ltt YY Ytttatltt„t l It t t,I t,lttt1011.•I.t1 <br /> SEMON 1 - Public Health Services Tracking Sheet will accompany each tank afrcced with its site identification number. <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 facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITYNAME: Tracy Joint Union High School District <br /> FACILITYADDRESS: 3'15 E. llth Street , Tracy, CA 95376 <br /> TANK [D #39 - J p7f�� Tank Description: 1 ,00Q p diesel fuel <br /> ............r....r.,rotaYl•,aaa•It1•ta,a atrtl lar•t11..aara.tr.......11......I...e............................ <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Wright Environmental Services, Inc . <br /> Address: 1961 Hill liew Way City: Tracy __ Zip: 95376 <br /> Phone #: ( 709 ) 818-0758 Date Tank Removed:--- _ <br /> •ItlIIlUaallY aJltlaaaaa♦taaaata•itHlt-t Htttll••IHttYt•aHalaHllti tlt Ya!l raeuru...rr.r H..o....r.v.rc. <br /> SECTION 3 - To he filled out by contractor "decontaminating tank!: <br /> Tank Decontamination Contractor: S .A.A . <br /> Address: City:_____ <br /> Phone #: ( <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner required Cal A. <br /> Signature: \ Title: JA) � <br /> aal...•....... Ytt•aaNtttl,atttttt•ttttHUtlttYHttt Htt Hit tYtta H••a1Nat Ytrt,ttaaHH.I t,Yt1,.Y•••... <br /> SECTION 4 - To be signed and dated by an authorized rep re ntative of the treatment, storage, or disposal facility <br /> accepting tank and/o piping. <br /> Facility Name: I <br /> U �1' p 22 <br /> Address: (� 5 Z —v V ' . -- City: Cl( U Zi `J <br /> Phone #: 11/ ) 4� <br /> Date Tank ZRcccij- � '2J- 2 't-:3 <br /> ,r-� -' <br /> Signat c / ___—_Title: r� <br /> ..•.I ttH to Yt.rl...otrl.ort..o,aaatast...Y...arr.atl.o.ar.aaa.ra.as,tltt,aa.HrtlaHaltOH..etaNetttH <br /> EH 23 049 (Revised 7-10-92) Pape 10 <br />