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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br />The Tracking Sheet Is to be returned to Public Health Services within 30 days of acceptance of the tapk by the disposal o <br />recycling facility. The permit holder u responsible for ensuring that this form is completed and returned <br />FACILPIY NAME Airport Passenger Inc. <br />FACII.t1YADDRESS: 2305 S. Airport Way, Stockton, CA <br />TANK ID #39- ?�47L) - (i' ? Tank De6cription: ?-000 gallon gasoline tank <br />•.•••.••.•••••••..•••.........•...........•...................................................•••••••••••• <br />SIi:CIYON 2 - To be filled out by tank removal contractor. <br />Tank Removal CoQuactor. Paydirt Excavating Co. Inc <br />Address 269 Oregon ST City: Ripon Zip: 95366 <br />Phone #: (_ 209 599-2347 Date Tank Removed: <br />.............................................................•...........................a....•.•.••.••••. <br />SECI'lON 3 - To be filled out by contractor 'decontaminating tank': <br />Tank Decontamination Contractor. Paydirt Excavating Co. Inc. <br />AddraL, 269 Oregon St City; Ripon ZIP: 95366 <br />Phone 0:f 209 599-2347 <br />Authorized reprrseatative of contractor certifying through signature below that the tank has been decontaminated In an <br />approved mann" as required by Cal EPA / - <br />'MIC: C F <br />....•...•........•............................................................... 0............•..••..••.•.. <br />SECTION 4 • To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />acmpung tank and/or piping, <br />FacUltyNa=Cal-Coast Mfg. <br />Addr"a 1540 Lynwood City: Turlcok Zip: <br />Phone r: f 1 209 668- <br />9382 <br />Date Tank <br />Title: s <br />IN 23 049 (Revised 1-10.92) Pana 10 <br />95381 <br />