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ST&Ij ,702i§,QLT1'N LOCAT HM T•TH DISTRICT <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 cermit with number noted below 1s responsible for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: <br />Reeal/Wickland Oil 11604 <br />FACILITY ADDRESS: 1448 N. E1 Dorado <br />TANK ID M39- <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: ^ wn And Cn inrry r•nn r^^•^-^ -In^ -- <br />Address: <br />117 Otto Circle Sac. Ca.ZipJ 95822 <br />Telephone: ( 916 ) 397-1860 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 />Phone#: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 />SIGNATURE AND TITLE <br />x*****ww***********xw***********x**x**x**xx************wwwww**w***w******w*ww*w*www*******w <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: 11315 SOUTH BRIDGE STREET, Zip: 95670 <br />RANCHO DORDOVA, CALIF. Phonel:916-635-6680 <br />Date Tank Received: <br />AUTHORIZED SIGNATURE AND TITLE <br />******************************************************************************************* <br />Ell 23 019 12/88 <br />MAILING INSTRUCTIONS: FOI.D IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />ATTN: UNDERGROUND TANK PROGRAM <br />P. O. BOX 2009 <br />STOCKTON, CA 95202 <br />