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..s <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVD20NNIENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1- Public Health Services Environmental Health Division Tank Tracking Sheet shalt 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: POSDRR Power Comnanv- T.-P <br /> - <br /> FACILITY ADDRESS: 2526 W. Washington Street,Stockton CA <br /> TANKID#39- TA95,isni TANK SIZE: 7 OOp PREVIOUS TANK CONTENTS: used oil <br /> SECTION 2 -To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Not Annl;rahla — Tank rn ho abandoned in—place <br /> Address: City; Zip: <br /> Phone p: ( ) Date Tank Removed: <br /> SECTION 3-To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: <br /> Address: Cit <br /> Y: Zip: <br /> Phone#: ( ) <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: Title: Signature: Date <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 /> iPhone k: ( ) <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 08/13/99) Page 10 <br />