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SAN dOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: ri rY f Stockton Parking <br /> FACILITY ADDRESS: northeast intersection of American St. & Washington st <br /> TANK ID #39 -g TANK SIZE: jD0PREVIOUS TANK CONTENTS: dytl H.. <br /> SECTION 3 - To be filled out by tank removal contractor: <br /> Tank Removal Coritractor:—Arhzanced GenEnvi ronmenta I , ine - <br /> Address: 180"3 W Marrh Tano // A City'�t�ele t Zip: <br /> 95267 <br /> Phone #: ( 2 n 4 ) 956-0964 Date Tank Removed: <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Advanced QQoFnVirnnmt-ntal Tn <br /> Address: 1801 W M h Lane, #A City: Stockton Zip: 95207 <br /> Phone ;: ( 209 ) 956-0264 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Timothy, real lar Title:Staff Geglogist 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 /> Facility Name: West Coast Equipment <br /> Address: 51 00 mayI n rn t City: ,� , _ Zip: 95381 <br /> Phone #: ( 2nq ) 6Aa 9372 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />