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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD *09600.0 ••• ••• H6•••0000••• • 0*06"0606.4006.4 0006000Hr• ••r••HON • • H H 0• ••s• 00 •• H0•••0•d00•••r•••000NH SECTION l - Public Health Services Tracking Sheet will accompany each tank afitxed with Its site Identification number. The Tracking Sheet Is to be returned to Public Health Services within 30 da n 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: M. C. Liquors FACILITY ADDRESS: 1628 Harbor Rd. Stockton, CA 95203 TANK ID •39 - + ` — Tank Description: 10,000 gallon ••r•••••••u•••••••rr•rr••••••••••••••r•r4•••••rr•u•••••••••••r•••••••••••••rr••••••6•r•r••••r••r•rr••66•• SECTION 2 - To be filled out by tank removal contractor: Tank Removal Contractor: Paydirt Excavating Co. Inc. Address: 269 Oregon St. Mr. Ripon, 7JP- 95366 phone*:( 2( O9 ) 599-2347 Date Tank Removed: SECTION 3 - To be filled out by conin ctor 'decontaminating tank': Tank Decontamination Contractor. Paydirt Excavating Co. Inc. Address: 269 Oregon St. qty Ripon VP: 95366 Phone*:( 209 ) 599-2347 Authorized representative of contractor certifying through signature below that the tank has been decontaminated In on approved manner as required by Cal EPA Signature: 91tw.. .••.••.....•......••.rrrr••r••6•••r••rue••••••r••••••••••r•Err•rr•••••.••.••rr•••••6••r•••r•rrrr••a•r•••• 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: Cal—Coast _Mf Address: 1540 Lynwood sty Turlock Mp: 95380 Phone N:( 209 1 668-9382 Date Tank Received: Signature: Title, Ea 23 049 ta•vlr•d r-10-92) PON 10