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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1-Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany eacti tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned 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 ensuring that <br /> this form is completed and returned. <br /> FACILITY NAME:John Taylor Fertilizer (Stockton Facility) <br /> FACILITY ADDRESS: 1819 South Argonaut, Stockton, CA <br /> TANK ID 039- Unknown TANK SIZE: 12,000 Gal/Split PREVIOUS TANK CONTENTS:Gas/Diesel <br /> i riif#+ir!#i#rW#ii#if###»+}#»#rrf##»#»»#;»iii»#Wfr;•ifirtfi;f»Wi»##iir#}#+!##ti Wi»##rW#!ti##i#r»iY4irr#i}iir»# <br /> SECTION 2 -To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Ramcon Engineering&Environmental Contracting,Inc. <br /> Address:PO Box 1026, City:West Sacto Zip:95691 <br /> Phone k: (_Ll 6 ) 372-7535 Date Tank Removed: <br /> SECTION 3-To be filled out by contractor"decontaminating tank": <br /> Tank Decontamination Contractor:Ramcon Engineering&Environmental Contracting, Inc. <br /> Address:PO Box 1026, City:West Sacto Zip:95691 <br /> Phone p: ( 916 ) 372-7535 <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 /> Nie:Michael Gereghty Title:PE Signature: Date 1/29/03 <br /> #r##rtr#rr#rtrr#•f###rr#rr####r#r#r;r»}r#4Y#+i+Y#Y#rt#ifrrfy}###;rrrrtiylrrt!##+rrr»rrlfrf•#rrsrlr#l4rirl4lrrirr <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:FCI <br /> Address:255 Parr Blvd. City:Richmond Zip: 94801 <br /> phone#: ( 510 ) 235-1533 <br /> Date Tank Received: <br /> Name: Tide: Signature: Date <br /> #is»rssir}#iii}ssY#irrrr#rY#Wls4+i#wsf#ff#+rsrrrrrrsWrsrrriirrY#f+liiri!!sY}»!}isiisfsr!}#rr#irr»irsilFrr <br /> EH 23 046 (Revised 08/13/99) Page 10 <br />