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i - UNDERGROUND TANK DISPOSITION TRACKING RECORD SECTION 1 - The San Joaquin Local Health District's Tracking Sheet Will accompany each tank affixed with its site identification number. The Tracking Sheet is to be returned to San Joaquin Local Health District within 30 days of acceptance of the tank by disposal or ruling facility. The holder of the permit with number noted below is responsible for ensuring that-this form is completed and returned--- FACILITY eturned_FACILITY NAME: Santa Fe Railway Co_ Fueling Facility FACILITY ADDRESS: Diamond and East North Street, Stockton, California TANK ID 139-- ��r*****�x*�rxx*�rx**�r**�r**�*****�**�*��**�rx**��****�**�x*x*x*�*��*****xx,tyr�xx�**��*��****max** SDCTION - 2 - To be filled out by tank removal contractor: Tank Removal Contractor: Environmental Solutions, Inc_ Address: 21 Technology Drive Zip: 92718 Trv3n¢, 1'al i fn- nia _ - -- - -- - -- - - -- -- Phone#: Telephone: ( 714 727--9336 pate Tank Removed: SECTION 3 --To be filled out by contractor "decontaminating tank": Tank Decontamination" Contractor: 'WQsfarn Me-t-Pr, Servire. Tnr Address: 2735 Teepee Drive, Suite E Zip: 95205 Stnckrnn„ eel z fnIM12 _T Phone#: —(209) 248-6124 Authorized representative of contractor certifies by signing below that the tank has been decontaminated in an approved manner as may be regulated by Department of Health Services. SIGNATURE AND TITLE SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, storage, or disposal facility accepting tank. Facility Name _ . Triangle. Il;c. _ _-- Address: 3525 52nd Street J Zip: 95823 'a Phone#: (916) 421-1990 Date Tank Received: • ----- AUTHORIZED SIGNATURE AND TITLE - Ell 23 049 12/88 MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. SAN JOAQUIN LOCAL HEALTH DISTRICT ATTN: UNDERGROUND TANK PROQ.AM