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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />••r••.u••••••u••.q.......•.••.••.••••••.••••.•.••r.••.••........•.•••••••••...••.•••..••.•...HH•H•r.• <br />SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed wath its site Identification number. <br />The Tracking Sheet Is to be returned to Public Health Services within 30 dun of acocptance 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 />PACILITY NAME: M. C. Liquors <br />FACILTiY ADDRESS: 1628 Harbor Rd. Stockton, CA 95203 <br />TANK ID 039.Tank Description;. 10,000 gallon <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 tf: ( 09599-2347 Date Tank Removed:_ <br />.................•.••.•.......•••.•..........•••...•.........•...........••.•..•••r•••.•r.••••.••.•••••.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. ClRipon <br />ty: Zip; 95366 <br />Phone /:2( 09 1 599-2347 <br />Authorized representative of contractor certifying through signature below that the tank has leen decontaminated In an <br />approved manner as required by Cal EPA. <br />71fle � rc <br />SEMON 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal fadfity <br />accepting tank and/or piping. <br />Facility Name: Cal—Coast Mfg. <br />Address: 1540 Lynwood Qty Turl oek Zip: 95380 <br />Phone i!: ( 209 1 668-9387 <br />Date Tank Received:// <br />Mile.— <br />EN <br />itle:— <br />EN 23 049 (Revised 7.10.92) PON 10 <br />