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TANK DISPOSITION TRACKING RECORD <br />........................................................................................................... <br />SECTION 1 - Public Health Services Tracking Sheet will accompany each tank afTAed with its site identification number. <br />The Tracking Sheet is to be returned to Public Health Services within 30 dais of acceptance of the tank by the disposal or <br />recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br />FACILITY NAME. DDRW-Tracy <br />FACII,IT1' ADDRESS: 25600 Chrisman Road, Tracy, California 95376 <br />TANK ID #39 - �S3b'�5Tank Description: 250 -gallon steel gasoline tank <br />SECTION 2 - To be filled out by tank removal contractor. <br />Tank Removal Contractor: IT Cornnrarinn <br />Address: 4585 Pacheco Boulevard <br />City. <br />Martinez <br />7j1)- 94553 <br />Phone #: ( 510 ) 372-9100 <br />Date Tank Removed: <br />July 13, <br />1992 <br />SECTION 3 - to be filled out by contractor •decontaminating tur: <br />Tank Decontamination Contractor. H&H Ship Service Company <br />Address: 220 China Basin Street <br />Phone #:( 415 1 543-4835 <br />City: San Francisco Zip: <br />94107 <br />Authorized representative of contractor certified by signing below that the tank has been decontaminated in an approved <br />manner as required by the State Department of Health Services. <br />Signature: <br />........................................................................................................... <br />SECTION 4 - To be signed and dated by an authorized rep. entative of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />Facility Name: H&H Ship Service Company <br />Address: 220 China Basin Street City: San Francisco Zip- 94107 <br />Phone #:l 415 ) 543-4835 <br />Date Tank Received: <br />Signature: <br />Page 10 <br />EH 23 049 (Rev 2/8/91) up <br />Title: <br />