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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD as+art»awssasrastt++satsraaraasaarraas+•a»saaasrr»rrrras+stststasssrtasra ars»staara♦ar•srrraa•saarrra• SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. FACILITY NAME: Tracy Joint Union High School District FACILITYADDRESS: 315 E . 11th Street , Tracy , CA 95376 TANK M #39 - s Tank Description: 1 , 000 ct diesel fuel _ •ssaaasssaatastasrstrarsrttarttrarassraasatrrssrasraarttasaaaaaaarasrstataaartsarraaar rsaaarrasrs sasrtss••a SECTION 2 - To be filled out by tank removal contractor: Tank Removal Contractor: Wright Environmental Services , Inc . Address: 1961 Hi 1 1 Vi Pa: Way City: Tracy Zip: 95376 Phone #: ( 2 n c) 8�3—n v S 8 Date Tank Removed: •aus•ararasraartrt»rattaaaartatarsutrasaaaatraaaarasaaatta•aratursrrraaa•»s••rsa•♦rar wasaratasaaar aaa SECTION 3 - To be filled out by contractor "decontaminating tank": Tank Decontamination Contractor: S .A .A . Address: City: Zip: Phone #: Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA. Signature: Title: arraaaatoataaarastaataastasss•as»rstsaattasraatasrtrrrs•sttrsartaaaarttatatattsas»rtta rasaaatsrrstasaaayr SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility accepting tank and/or piping. Facility Name: Address: City: Zip: Phone #: (_� Date Tank Received: Signature: Title: r••saauttaaautatasrtaarassrarsata»asatttartas»saatat+attats•raattaartrtaasa rar••raarr tasssaaa satsur EH 23 049 (Revised 7-10-92) Page 10