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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> _ . . . . .. . •.. x. ..{r....V...+.raw+++.l++++1+.+•+++++.vl+++•+.f+•+•vO G++f 4:In+crr.f¢N x..�0:tiat+a.+:'. <br /> SEC1710N 1 - Puhiic Health Services Tracking Sheet will accompany each tank affixed with its site identltir�+ion o aa:t�r. <br /> The Trackico Sheet is to be returned to Public Health Services within 30 dans of acceptance of the tank by 4-9 dti;ta a1 or <br /> recycling recl:i+.y. The permit holder is responsible for ensuring that this form Is completed and raturncd. <br /> FACILITY NAME: Stockton Metropolitan Airport_- Federal Aviation Adminl=tration, _ <br /> FACILITY A)W)RFSS: Airport Way, & Ai%-h Road, San Joaquin Co., Stockton, CA __- _ <br /> Tr.NK 1D #34- _ Tank Description' l�g(41- d46a-1 URT rerr 4_0 —. <br /> r.+..•u1••MtN.l0000o00001N0o000/f/Rf0?tt-o6tf4 got•••lffotfff•••o•!+!+!l.++l a.+sv+tt+++e to, <br /> SECUON 2 - To he filled out by tank removal contractor: <br /> Tank Rvnvn YAContractor: T= MA rinaar [rinsrrunt4nn. Tne_ ---„-•_„, <br /> Address:_._ _ 1820 Bidwell Street City: Red B1t f1CA ..ip <br /> Phone #: ( 916 ) 527-5014 Date Tank Removed: April 15. 1954 <br /> sttl+l+ ftftff•fu•ttftft+tf•ffneft•fft.attt+rtf+e+.f"!fp{�ti <br /> SECriON 3 I'n be filled out by contractor'decontaminating tank': <br /> Tank Dcc(iRr3nlination Contractor: TtVA Miahrinctey. <br /> Address:_„ . , _ 1820 Bidwell StrAet _. City-Red Bl f. CA <br /> Phone W: (.. .416_) 527-5014 _.-.• •_._ <br /> Authorized r: i-n:tenialive of contractor certifying through signature below that the lank has been docontaminarM in an <br /> appruvcd mjr•ncr aS required by Cal RPA <br /> r/ e, <br /> _ Signature: �s - Title:_ <br /> 7txn Ftehri er <br /> 11M•tH IYf...a!•t+I+it•ttl/f••i1!•t♦oYt!•Htttt•tI+•N•••ft�!!•f•/tNOM•lf ltf/f+t1u••♦+tt+t.++at+{•f+♦t+ <br /> SG:CTION 4 • 'fo he signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> :rcepung tank and/or piping. <br /> FaciliiyMx. % _.- H&H SHIP SERVICE OD. _... ... <br /> Address:_ 220 CHINA BASIN STREET City: SAN FRANCISM zip: CS 94107 <br /> 543-4835 <br /> *Date TankPcc.ived: 1$ APRIL 94 <br /> Signatures..,,.� Title: PRESIDENT <br /> t++++++.+`�"�1•ettttM•+++oNNf++•NoofftNtotf Mtf►oNf•ttM lofMMtt•tl it t•oi+f.N tNttf tl s+Yt Moot+f <br /> Es 23 069 (irvi xcd i-10.92) Pap to <br /> *copy of completed manifest = attpched <br />