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1 <br /> SAN JOAQLTEN COL`i`iTY PUBLIC HEALTH SERVICES <br /> ENVIROrIv1ENTAL HEALTH DIVISION <br /> UNDERGROLNID STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> this form is completed and returned. <br /> FACILITY NAME: The Record, Stockton Newspapers, Inc . <br /> FACILITY ADDRESS: 530 E. Market St . , Stockton , CA 95202 <br /> TANK ID#39 - TANK SIZE: 10 ,000 gal PREVIOliS TANK CONTENTS: Unleaded gasoline <br /> SECTION 2 -To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil , Inc. <br /> Address: P.O. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone#: ( 209) 368-6175 Date Tank Removed: 020,03 <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil , Inc. <br /> Address: P.O. Box 357 City: Lodi , CA Zip:95241 —n'�57 <br /> Phone#: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Jim Thorpe Oil , ITiide:C-on .r .ter Signatu Date O <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: WEST COAST EQUIPMENT <br /> Address: 1221 S. Tegner Road City: Turlock, CA Zip: 95380 <br /> Phone#: ( 888 ) 866-8265 <br /> Date Tank Received: <br /> Name: )) ems—_Title: Signature: <br /> EH 23 046 (Revised 08/13/99) Page 10 <br />