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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> .+r+rrrrrrrrr++rrrr+r rrrrrr•rrrrr rrrrrr rr+rr•urrrr+rrrr+rrrrrrrrrr rrr+••rrrrrrrrrrrrr+rrrrrrrrrrrrr+rrrp• <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed 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: USA PETROLEUM <br /> FACILITY ADDRESS: 2132 E. ."1ariposa Road, Stockton, Ca <br /> TANK ID #39 - 4'4Tank Description: 12,000 GALLON, IN, FAT) T) GASOLINF <br /> ...rrrrrrrrrrrr��rr.,,,rrrr.r.rrrrrrrrrrrr.r+rrrrrrrrrrrrrrrrririrrirrrrrr.rrrrrrrrrrrrrrr+rrrrrrrr+rrrr.• <br /> SECTION 2 - To be filled oyt by tank.remnval tpntrantor. <br /> Tank Removal Contractor:__ 1'c11 (: ���\ 1 <br /> Address: ` ..�5 lV r1 �' ( City. VDt-d-il zip: <br /> Phone #: ( CL ) � 2 J30 Date Tank Removed: 17 November, 1997 <br /> ......»rrru++rrrrrrrr•rrr++rrrrrrrr++rrrrrrrr rr rrrrrrrrr.r....r.+rrrrrr•rr+rrrrrrr+rrrrrrrrrr+rr•+rrrrrq• <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: IAMFS J. N()RI IT7FI I TV <br /> Address: P.O. BOX 30331 City: STOCKTON,CA zip: 95213 <br /> Phone #: 2( 09 943 7793 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner. <br /> Signature: 1-4 J� � Title:fenrro <br /> rrrrrirrtrrttirrtttirr ♦titrrrirrtr WwiN rrrirrrrrr Hrrrrrr+r rirrrbri YrtrMrrtlrtiirrrrrtrrrrirr+rttrrt <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: CAI Cf)A4T MF(-,- int^ - <br /> Address: P.O. BOX 1864 City:TURLOCK, CA zip: 95381 <br /> Phone #: ( 209 ) 668 9378 <br /> Date Tank Recei Af,2STO <br /> Signature: Title: <br /> •rsrrrrrrr r4rwrr+rrr rrrrr rrwr+rrrrrrrr rYs+Yr rirrrrrrrr+Yrrrrrtrtrii Yr Vrrrrrrrrrrrrr.rrrrrrrrrrrr.r.rrrrr <br /> EH 23 049 (Revised 7-10-92) Paye 10 <br />