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UNDERGROUND &FORAGE TANK DISPOSITION TRACKING RECORD <br />SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with Its site Identification sumirer. <br />The Tracking Sheet Is to be returned to Public Health Services wlthlu 30 days of aexcptance of the tank by the dbpoaal . <br />recycling fadllty. The pe!rmIt holder b responsible for ensuring that this form Is completed and returned.or <br />FACILITY NAME: M. C. Liquors <br />FACILITY ADDR M: 1628 Harbor Rd. Stockton, CA 95203 <br />TAM ID039. I I!?l—Ql Tank Description'!- 10,000 gallon <br />•••••.••••••setae••r••a••urr•e•••••••r•••••r•••r•rrr••err•••••••r••••••••••..•••••�•••••••••••.••••..•.••• <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Paydirt Excavating Co. Inc. <br />Address: 269 Oregon St. qty: Ripon, Zip- 95366 <br />Phone e9: 2( 09 1 599-2347 Date Tank Removed: q T- <br />o******, 0 *Go*** 0 ** 0 06**066*06 *00*0000000*000 a*.* <br />-•r••••••••••••.•••••••••••err••••r••••r••.••••.•.••.•rrrr•0000*r••••.. <br />SECTION 3 - To be filled out by contractor 'decontaminating tank': <br />Tank Decontamination Contractor. Paydirt Excavating Co. Inc. <br />Address. 269 Oregon St. <br />qty: Ripon 71p: 95366 <br />Phone •: 2( O9 1 599-2347 <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 />61-�t <br />Title: l ' 1'L <br />SECI ION I - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />Fa:filty Name: Cal—Coast Mfg. <br />Address: 1540 Lynwood qty. Turlock Zip, 95380 <br />Phone tit: ( 209 ) 668-9382 <br />Date Tank Received: L/ <br />Signature: 71thr. j <br />•u••••••••••r••••••••••••••rr•••r•r••••••rr••r•••••rr••••rr•••tar••••rr••••••••••rr••r•••r•••r.••..a..• <br />EN 23 049 (Rwised 7.10-92) ►qct 10 <br />