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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site identifigatlon number. <br />The Tracking Sheet Is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br />recycling facility. The penult holder is responsible for ensuring that this form is completed and returned. <br />FACELny NAME; Airport Passenger Inc. •• <br />FACILnyADDRESS• 2305 S. Airport Way, Stockton, CA <br />TANK 1D /139 - 2 - 01 Tank Description: inn 8, l i „n a; o�oi <br />SECTION 2 • To be filled out by tank removal contractor: <br />Tank Removal Conaactor. Paydirt Excavating Co. Inc <br />Address 269 Oregon ST City: Ripon Zip: 95366 <br />Phone #: (----)209 599-2347 Date Tank Removed: <br />....•....................................................................................................•. <br />SECTION 3 - To be filled out by contractor 'dcoontaminating tank': <br />Tank Decontamination Coutractor. Paydirt Excavating Co. Inc. <br />Address: 269 Oregon St City: Ripon tip: 95366 <br />Phone #:f 209 599-2347 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated la an <br />approved manna as required by Cal EPA <br />I7 <br />Title: C '(f <br />SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />ascept.4 tauk Rut"t piping. <br />FadUty Name:Cal-Coast Mfg. <br />Addreec: 1540 Lynwood City, Turlcok Zip: <br />Phone 0: L _ <br />209 668-9382 <br />Date Tank <br />Title: <br />[M 23 049 (Review 2.10-92) Papa 10 <br />95381 <br />