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UNDERGROUND STORAGE TANK DLSPOSMON TRACgIIgG RECORD
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<br /> SECTION 1 - Public Health Services Tracking Sheet will a=mpay each tank affixed with its site identification number.
<br /> The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or
<br /> i recycling facility. The permit holder is responsible for ensuring that this form is completed and returned.
<br /> S
<br /> FACILITY NAME Stockton Steel
<br /> FACILITY ADDRESS: 3003 E. Hammer Lane Stockton, CA 95208
<br /> TANK ID #39 - Tank Description:
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<br /> SECTION 2 -To be filled out by tank removal contractor.
<br /> J Tank Removal Contractor. DECON Environmental Services, Inc.
<br /> i
<br /> i . Address: 23490 Connecticut Street City Havward Zip: 94545
<br /> _4
<br /> Phone #: 5( 10 ) 732-6444 Date Tank Removed:
<br /> SECTION 3 - To be filled out by contractor 'decontaminating tank':
<br /> Tank Decontamination Contractor. N/A
<br /> 7
<br /> Address: City. Zip:
<br /> Phone #:
<br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an
<br /> approved manner as required by Cal FPA
<br /> Signature: Title-
<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:
<br /> Address: City-_Zip:
<br /> Phone
<br /> Date Tank Received:
<br /> Signature: Title:
<br /> ....>.>...............•...,.,..>.......>..............>.»...............a..........>...................
<br /> EH 23 049 (Revised 7-10-92) Veae 10
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