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PUBLIC HEALTH SEWICES ..�0� <br /> Z <br /> SAN JOAQUIN COUNTY �' < <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> P.O. Boz 2009 • (1601 East Hazelton A,%Ie) • Stockton,C nfmd2 95201 <br /> tiFiid <br /> (209)468-3400 <br /> DISPOSITION TRACKING RECORD <br /> CCff�rpp'' <br /> HtRUftf HtNHtltttAf tuft l Jld^) f fftfflgUp+•i}fHtttf}tt+Htttf Ht+f1lftf Nfftttttt•+Ht•}t <br /> It accompany each tank affixed with its site identification number. The <br /> SECTION 1 -Public Health Services Tracking Sheet wi <br /> Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling <br /> facility. The permit holder is responsible for ensuring that this form is completed and returned. „ <br /> FACILITY NAME: CAPITAL VENTURE ENTERPRISES <br /> FACILITY ADDRESS: 474 S. Aurora, Stockton CA <br /> TANK ID #39 - Tank Description: 1 - 55 gallon openhead drum <br /> ♦tt+111111}tfttltttftlt}f•ttttlftttftttlttttt♦!ltt+}111111♦ftltt}tft+tf ttf tttt}ttltttttttf}t++tt Rttltttl+• <br /> SECTION 2 - To trued out by tank removal JIM OIL, INC. DBA RICH-MART CONSTR. <br /> Tank Removal Contractor: <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241 -0357 <br /> pkwt'm <br /> Phone #: ( 209 ) 368-6175 Date Ta Removed: 11/25/91 <br /> ♦tutfuftfft•ttt+ttt}ftf ettttf»altfttttf+fft}}ttlt!luft!•}t!u}t•}tf••}f tf tJ!•t+tftft•••lttrtt+tt}at!!• <br /> SECTION 3 - to be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL, INC DBA RICH-MART CONSTR /HaulerloNrinsate <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized representative of contractor certified by signing below that the lank has been decontaminated in an approved <br /> manner as required by the Stat wof Ith Services. <br /> Signature: � Title: Vice-President <br /> Drum r of all u es and h� ocarbon vapgr�s �iR4P c�gijy�ry+$p,f$��4{11ti€rtte€�...f+f <br /> ..attt t.ft. f..f}+.aal. ....Wd h. ..ftt bon . }. }+ <br /> SECTION 4 - be signed and dated by an a orized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City:Ranrhn Cordova - Zip: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: 11/25 <br /> Signature: Title: <br /> M tY ttfMf HfNHMtfftHffl HftM •tttYttflMff+tt#f!t•+f fYtti Nff RttlYltH}1♦##Nttf ttN tY#tt#!•Rtfftf lt! <br /> Page 10 <br /> EH 23 049 (Rev 2/8/91) wp <br /> A DIAston of San Joaquin County nealhh Care SeMces �� <br />