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SAI* .70A,,_,J3:W LOrzar. HE=AT-T DIS1rE2ICT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> affixed with its site identification number. The Tracking Sheet is to be returned to San <br /> Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. The holder of the hermit with number noted below is responsible for <br /> ensuring that this form isccoo }pleted and returned. <br /> FACILITY NAME: Franks Exxon #2 <br /> FACILITY ADDRESS: 1399 East Yosemite Avenue , Manteca, CA 95336 <br /> TANK ID #39- 1464 - C4 <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: B & C Construction Company <br /> Address: r:6`17 N 1`ersh1ng, A-3, Stockton, CA Zip: 95207 <br /> Phone#: (209 ) 9�1-93C4 <br /> Telephone: ( � ` ) i ! 1 1 °1 Date Tank Removed: <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: Shaw I',Pintenance Company <br /> Address: 928 W. Glenwood Avenus Zip: 95380 <br /> Turlock, Ca Phone#: (209) 668-8441 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decont4minated in an roved manner as may be regulated by Department of Health Services. <br /> SI TUBE AND TITLE <br /> ###x############x# ##xxx#xxx##x####### <br /> SECTION 4 - To be filled out and signed`b� a authorized represnetative of the treatment, <br /> storage, or disposal facility accepting to <br /> i <br /> Facility Name �G7 P . �' 'v ' <br /> r v'c7C <br /> Address: �i — Ave, 62a d. Zip: <br /> Phone#: c/o- - / t' <br /> n <br /> Date Tank Received: <br /> I ZE.D SIGNATURE AND TITLE <br /> EH 23 049 12188 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. 41 . <br /> 9 <br /> SAN UIUNDER(ROUNDL <br /> TH DISTRICr <br /> ATTN: TANK PROGRAM CFs <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />