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t--- 1( -- - <br /> D <br /> Dec 10 1511:45a American Valley Waste Oil C', E p.1 <br /> ----------- --- - - . ... <br /> DEC 10 2015 <br /> ENVIRONMENTAL <br /> TU nC0A0T0A0A1T <br /> ENVIRONMENTAL HEALTH IRf <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209)468-3433 SEE' 15 2015 <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING �� QNMENTAL <br /> SECTION 1 — SJC Environmental Health Department's Tank Tracking Sheet shall accompany each tank affixed with its site <br /> identification number. The Tank Tracking Sheet is to be returned to the Environmental Health Department within 30 days of <br /> acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed <br /> and returned. <br /> FACILITY NAME: City of Stockton-800 East Main <br /> FACILITY ADDRESS: 800 East Main Street,Stockton,CA 9 202 <br /> TANK ID#399--0�70' 3 TANK SIZE: '7 D2� PREV Ol3S TANK CONTENTS: I^ r C <br /> SECTION 2-To be filled out by tank removal contractor. <br /> Tank Removal Contractor: Advanced GeoEnvironmental,Inc. <br /> Address: 837 Shaw-Road City: Stockton zip: 9521 <br /> Phone#: 2t 09 1 467-1006 Date Tank Removed: <br /> SECTION 3-To be filled out by contractor"decontaminating tank": <br /> Tank Decontamination Contractor: Advanced GecEnvironmental Inc. <br /> Address' � City: it Zip: n <br /> Phone#: ( K ) <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. q _ <br /> kJL SIJI. (Xf O Title: 68b f 1N��/X, Date (Z b ` ` -- <br /> Name: /� tS'�' Signature: <br /> SECTION 4-To be signed and dated by an authorized representative of the treatment,storage,or disposal facility <br /> accepting tank andlor piping. <br /> Facility Name: •dm8'� \ "� , <br /> 2 n n /� � G <br /> Address: Po FF'1 --7+.7��O cPdhi C.eG "ro f� City:�� Zip: � ✓L <br /> Phone#:(�()� l D�� T'� d V� <br /> Date Tank Received: 6 <br /> Name. Title: 6&QAVg Sigrature: J Date 2' <br /> EH 23 046 (Revised 07/17/14) 9 <br />