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SAN A. QUIN COi1NTY PUBLIC HEALTH SERhttiES <br />ENVntONMENTAL HEALTTi DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRAC NG RECORD <br />•wwwiawMM#f[.Ri4YM.'Yf,W.yMMRMMN*M.k;M fipbwwMwMMWWYMMMMMwMMMMM/#a.+F wwy <br />SECTION I - Public Health Services >ravimnmeaal Health Division Tank Tracking Sbeet shall a=mpany each tank affixed with <br />as site identifcatiou number_ The Tank Tracking Shect is to be rettuaed to Public Health Services Environmental Health Division <br />within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for mtsuriug that <br />this :orm is completed and reamed. <br />FACIL1TY-,gA.N,M: San Joaquin County Mosquito & Vector Control District <br />FACIIITY ADDRESS:7759 South Airport Way, Stockton, CA 95206 <br />TANK ID #39 - 2 TANK SIZE: 10,000 Gal PREVIOUS TANK CONTENTS: Mosquito Abatement Oil <br />:aasaksaaxs��iswwWH.rwrYriw:wriaaaea+e#ar»Y+Y+rfM WIMIMMMMtMM MMW <br />SECTION 3 - To be filled opt by tank removal contractor. <br />Tank Removal Contractor. Ramcon Engineering & Environmental Contracting, Inc. <br />Address: 3751 Commerce Drive Chy: W. Sacramento Zip: 95691 <br />Phone #: (-21-6--) 372-7535 D=T=kRemaved <br />MiW�+YY�MAMMwwr.. YYwYY <br />SECTION 3 - To be filled out by cmnraaar "demn tonic^: <br />Tank Decontamination Couuacmr. Ramcon Engineering & Environmental Contracting, Inc. <br />Address: 3751 Commerce Drive City: W. Sacramento Zip: 95691 <br />Phone #: 16 372-7535 <br />Amhor=ed representative of contractor certifying duough Signature below that the wait Sas been decontaminated m an approved <br />manner as required by CAI EPA. <br />Name: Rollo Stephens T"nle• Operations Managerszaature; —Date <br />#MWMWFIMIMMIYM1YfMwW WIIpMMM#MWwwMJMWY#MMYR�MMM'dbMMMfwi M.4YVYi.YiYwM'twWfMultFww�WwY.MW wwMwMRYw <br />SECTION 4 - To he signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />aceeptmg tank and/or piping. <br />Fac ity Namc_ <br />E2 <br />Phone #: <br />Dace Tank Reteived- <br />Name• i"rtie �gnamre: Date <br />n++MwMt#�+�MnwaM�wM:+ewMas�a�w+MM�MMwMOM+MMMMMaatwa�+...+++saw <br />EH 23 046 (Revised 10/19/9M Page 10 <br />