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UNDERGROUND STORAGE TANK DISPOSITION TRACI{ING RECORD <br /> ssstss#■atsaaatrr/rrrsassattttstrrsssss/titisrrsrssssssrtattatsaaaattstattttt#r/sttsarr/!/rrt#rttstt*astsst <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site ident'if'ication 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 /> recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: NnNF <br /> FACILITY ADDRESS: E07 LFVTNSnN STRF STarjo- CA 9522 <br /> TANK ID #39 - Tank Description: S(} (,Ai i nN (FST)-.Gm,, nl TNF <br /> ••i###//rr///tri•i••r/■i#aaata•Riati+lltat rr rlrr titrtri\tatwtti tttittt#tttt#tri##rr t/#/r#tr alriSr/ta r#arta aa/ <br /> SECTION Z - To be filled out b tank removal contractor: <br /> Tank Removal Contractor: ALCN ENFR(-,Y _ <br /> Address: Box 1257 City: STOCKTON,CA zip: 95201 ^r <br /> Phone #: ( 209) 4E3 2108 Date Tank Removed: <br /> /•rs•r/r///t//s■sitrrrssrrtasaatrisrirrrrtt•rarrtsrtsttatratrsstrsssrsrrtrtr•rr/a#/•#//rtr/r#r#•##/sitsiit• <br /> SECTION 3 - To be filled out by contractor 'decontaminating tank': <br /> Tank Decontamination Contractor: FALcoN ENERGY <br /> Address: P.O. Box 1257 City: STxKTON,. CA zip: 95201 <br /> Phone #: t 209 463 71.08 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA. <br /> Signature: Title: <br /> s##ssrss/ss/#tri/#//sats#tarsi/rrtt//r#rrrr#//#s/sttstat/s/#/♦•as#•atsrsstartrs///r#/ss sssssrs#rts#►sstrsat <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 /> Facilitv Name: THE LEARNER COMPANY <br /> Address: 2700 NAVY DRIVE City: STOCKTON, CA Zip: 95203 <br /> Phone #: 20( ) 9483498 <br /> Date Tank Received: <br /> Sicnature: Title: WE I GHMASTER <br /> •rs�#arat•ssstasts#s#tttsttsssr##sstr#ss###ssssettsttetsssa#tet#sssttrsssrttssarssssrsasssssssssa#asassr <br /> _�4 73 ,49 (Revise¢ 7-1(}-92) <br /> Page 10 <br />