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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRON\fNTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its site identification number. The Tanis Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: --_Mp j,. e__netra.3 eum <br /> FACILITY ADDRESS: 2191 Navy Dr. Stockton Calif <br /> T.-MNK M #39 - TANK SIZE: PREVIOUS TANK CONTENTS: <br /> �s*s*+k�e**�**Me%e k�*k k k k+t It*+k k s+k F F+k M M k+k+k k k*�ekYs*k•f�+kk ye*���t�*�*kf�feye�*ye�yei�**��i*�*�*Klk*ale****#fk*k+k�***�******** <br /> SECTION 2 - To be Filed out by tank removal contractor: <br /> Tank Removal Contractor:_ S et_ Ceest—ueti . <br /> Address: P. O. Box 737 City:Valley S ringZip:_ 95252 <br /> Phone #: (209– ) 931-5513 Date Tank Removed: <br /> SECTION 3 - To be ftlIed out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Same as 2 <br /> Address: City: Zip: <br /> Phone #: (T� <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: Title: Signature: Date <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: <br /> Address: City: Zip: <br /> Phone #: (� <br /> Daze Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />