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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD tttf Fffttrltt Fffttttttrt•ttttt••stiff••tttttttt•fftttffftf tttt tf•tttttt•t•tt•t,f t•f,f tt t•Ff ff ff•f tttfff fftt SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affbted with its site identification number. The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. FACILITY NAME: TOWN & COUNTRY HAY & FEED FACILITY ADDRESS: 4145 E. MAIN STREET, STOCKTON, CALIFORNIA 95215 TANK ID #39 - )C �f' / Tank Description: to o Cte LYC�t ....a..•••..•...••FfF••.•.,..fff.�.e.,tF...f.....a...aata...FF...•a..aat. SECTION 2 - To be filled outbytan tNERa contractor: L Tank Removal Contractor: tY A Address: BOX 1257 City: STOCKTON,CA Zip: 95201 Phone #: ( )ng ____q63 ]108 Date Tank Removed: ...........................f............................................................................... SECTION 3 - To be filled out by contractor 'decontaminating tank": Tank Decontamination Contractor: FAi CSN FNFRGV Address: Box 1252 City: STOCKTON, CA Zip: 95201 Phone #: ( 20 463 ]108 Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA Signature: Title: tratf•arta••t•t•ttatfu,•art•t•ta•that,aa•faa•ttsft•ta♦f•aar••suffaf•ffffffaa aatf•a tt• SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility accepting tank and/or piping. Facility Name: TNF I FARNFRrf)MpANV Address: 2711 NAVY DRIVE City,. STOCKTON, CA Zip: 95203 Phone #: ( /ng ) y48 5498 Date Tank Received: Signature: Title: ..,rata•.a••,a••,,,a••r•,Faaatrtrattatttttatt••••att•:..•,...•.t,ta•fFaf•tttta rtf»••r••• EH 23 049 (Revised 7-10-92) Page 10