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SAN aOAQLJIN LOCAL HEALTH DISTRICT <br />h�s•r•R ••R• • ••• •sr�;_k <br />SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with its site Identification number. The Tracking Sheet is to be returned to San <br />Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br />recycling facility. The holder of the permit with number noted below is r sponslble for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: STEVES RENTAL <br />FACILITY ADDRESS: 275 E. GRANT LINE ROAD TRACY, CA. 95376 <br />TANK ID 139- - <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor:(TECC) THE ENVIRONMENTAL CONSTRUCTION COMPANY <br />Address: 259 KINNEY DRIVE SAN JOSE, CA. Zi • 95112-4433 <br />Phone#:(g08) 997707- <br />Telephone: ( 408 ) 997-1505 Date Tank Removed: <br />****txR*x******#*****x**##***xxx*x***x******x***k********k**x*x*#*x********xx##*kx*x***xx** <br />SECTION 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: H&H SHIP SERVICE <br />Address: <br />zip:94107 <br />(Li15) 5L�3_4R35 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in an approved manner as may be regulated by Department of Health Services. <br />SIGNATURE AND TITLE <br />Rfi**k**R**tfi*■R**********R****fi***************x******xk**k*************************fi**k*k*k <br />SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br />storage, or disposal facility accepting tank. <br />Facility Name H&H SHIP SERVICE <br />Address: <br />Date Tank Received <br />FRANCISCO, CA, <br />AUTHORIZED SIGNATURE AND TITLE <br />Ell 23 019 12188 <br />MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />AWN, UNDERGROUND TANK PROGRAM <br />P. 0. BOX 2009 <br />STOCKTON, CA 95202 <br />Zip; 94107 <br />:(415) 543-485 <br />