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• a • • <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> saa}»»}aa>rraarrra>a>rrrrraas}aaaraasaaaarr}aaaasaasa>raaraasa}ar»aasaa>>aaraaaraaaaaaaaa>rar}ra»a>»sra <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank aged with its site identification number. <br /> The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance 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 /> FACILITY NAME: Proposed Tosco Fuel Facility #02479 <br /> FACIIITY ADDRESS: 7647 Pacific Avenue at Rivara Road, Stockton, CA \ <br /> TANK ID #39 - Tank Description: Unknown size waste oil TBD <br /> >}}»»>faafaa>a>a>i>iii}i!>r}r}!!>!a>»»»!>faf>i>}}>r!>ri»afif>r>ai>i>irr>laax{ iii»>»ilii}ii{i>r <br /> SECTION 2 - To be filled out by tank removal contractor. <br /> Tank Removal Contractor. Advanced Environmental Services, Inc. . <br /> Address: 1419 North Market Blvd. , Suite 5 City: Sacramento Zip:95834-0457 <br /> Phone #: ( 916 1 928-8300 Date Tank Removed: <br /> 1 <br /> aa{{qsssa:iw>aaw>aw}{{»>arq>rr»rras».{»>isi>•rss♦rss>aaaarir>i>a>iwwswa{>♦r>w>wrarsra»wrrasas>s»w{{{rxx» <br /> SECTION 3 -To be filled out by contractor 'decontaminating tank": �/- <br /> Tank Decontamination Contractor. advanced Envi ronmental Services Inc fie; "N6 ! r�?oft <br /> Address: 1414 North Mark . Blvd. . 211 i . 5 City. Sacramento Zip:95834-0457 <br /> Phone #: 9( 16 ) 928-8300 <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 /> Signature: Title: <br /> {>ax»»}>s»ss}aaaasasasia>a>ar>saaassaa»s»a}rr>sss>as>asi>wrr}asaaaw>as>r>raa>aas»asasaa»»rra»a»aw>xr <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Erikson <br /> Address: 3033 Richland Pkwy, Suite 300 City: Richland Zip: 94801 <br /> Phone #: 5( 10 ) 235-1393 <br /> Date Tank Received: <br /> Signature: Title: <br /> xwaarx{saga{x»{{»aassaxs»aaaq{a>rwaiaaaarssssisa{s»a>aassa»aaiaiaa}x>rxxaar{>raa:saxx:w>{r{arra»xixxxx <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />