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SAKI 70AQV1N LOCAL T;F'Ar•TH D25'I'F2ICT <br />UNDERGROUND TANK DISPOSITION TRACKING RECORD <br />SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with its site identification number. The Tracking Sheet is to be returned to San <br />Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br />recycling facility. The holder of the permit with number noted w is responsible for <br />ensuring that this form is completed and returned <br />FACILITY NAME: Regal/Wickland Oil 11604 <br />FACILITY ADDRESS: 1448 N. El Dorado <br />TANK ID 039-�' <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: 'rown And Country Tnc - <br />117 Otto Circle Sac. Ca.95822 <br />Address: Zip' <br />PhoneO: 392-1860 <br />Telephone: (qj6 392-1860 Date Tank Removed: <br />SECTION 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: HERBST ENGINEERING INC. <br />Address: 5980 -24TH ST. SACRAMENTO, CA.95822 Zip: 95822 <br />Phone0:916-422-2628 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in an approved manner as may be regulated by Department of Health Services. <br />SICNATURE AND TITLE <br />SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br />storage, or disposal facility accepting tank. <br />Facility Name CROSS EQUIPMENT COMPANY <br />Address: <br />11315 SOUTH BRIDGE STREET <br />Date Tank Received: <br />Zip: 95670 <br />;916-635-6680 <br />AUTHORIZED SIGNATURE AND TITLE <br />******************************************************************************************* <br />Ell 23 049 12/88 <br />HAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />ATIN: UNDIM-GROUND TANK PROGRAM <br />P. O. BOX 2009 <br />S'IVCKTON, CA 95202 <br />