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SANJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 — SJC Environmental Health Department' s Tank Tracking Sheet shall accompany each tank affixed with its <br /> site identification number. The Tank Tracking Sheet is to be returned to the Environmental Health Department within 30 <br /> days of acceptance of the tank by the disposal or recycling facility . The permit holder is responsible for ensuring that this <br /> form is completed and returned . <br /> FACILITY <br /> NAME : DBL Rentals <br /> FACILITY <br /> ADDRESS : 619 and 625 South Sacramento Street, Lodi, CA, 95242 <br /> TANK ID #39 - TANK SIZE : 500allg on PREVIOUS TANK <br /> CONTENTS : naso ine <br /> SECTION 2 - To be filled out by tank removal contractor : <br /> Tank Removal Contractor: Valued Engineering <br /> Address : 10409 Lonestar Way City: Stockton Zip : 95209 <br /> Phone #: 2( 09 )_177 - 4500 Date Tank Removed : <br /> SECTION 3 - To be filled out by contractor " decontaminating tank" : <br /> Tank Decontamination Contractor: Valued Engineering <br /> Address : 10409 Lonestart Way City : Stockton Zip : 95209 <br /> Phone M209 ) 477 - 4500 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved 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 /> Facilit <br /> Name: West Coast Equipment <br /> Address : P . O . Box 2368 City: Turlock, CA Zip : 95381 <br /> Phone #: <br /> ( 800 ) 441 - 8544 <br /> Date Tank Received : <br /> Name : Title : Signature : Date <br /> 9of10 <br />