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SAN JUAQUIN COUNTY PUBLIC HEALTH SERRCES <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 each 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: <br /> FACILITY ADDRESS: 730 E Channel St Stockton, CA <br /> TANK ID#39- TANK SIZE: 1 000 PREVIOUS TANK CONTENTS: Unknown <br /> SECTION 2 -To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Oil Equipment Service <br /> Address: P.O. Box 950 CitySan Andreas Zip: 95249 <br /> Phone N: ( 209 ) 754-1808 Date Tank Removed: <br /> SECTION 3-To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Oil Equipment Service <br /> Address: P.O. Box 950 CitySan Andreas Zip: 95249 <br /> Phone N: (_2 0 9 ) 754-1808 <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: Keith A. Tallia Title: Pres. Signature: Date . <br /> Keith A. Tallia <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 E ui <br /> Address: P.O. Box 2368 __ City: Turlock Zip: 95381 <br /> Phone#: ( 209 ) 668-9378 <br /> Date Tank Received: — <br /> Name: Title: Owner Signature:_ Date <br /> Louie Baptista <br /> EH 23 046 (Revisrd 03/13/99) Page 10 <br />