Laserfiche WebLink
UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •••.•rr••r••••r•,••••••••ur•r••r••••••••rr•••••••••••••r••••u•••••u••r••••••••r•r•»••r••••••••••••••••• <br /> SF,CI'ION I. - Public Health Services Tracking Sheet will accompany each tank affixed with its site Identification 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: JOLLY JOE'S BAIT & TACKLE EPA Site (ICAC 000896616 <br /> FACILITY ADDRESS: 101 W. Charter Way, Stockton, CA <br /> TANK ID #39 - - Tank Description: 1 - 550 Gallon Diesel/ Gasoline Waste Oil <br /> SFCI'ION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil Inc. DDA Rich-Mart Construction <br /> Address: 3 )1 N. Beclanan Rd./ P.O. Box 357 City: Lodi, CCA Zip: 95241-0357 <br /> Phone #: 20( 9 ) %2-4581 Date Tank Removed:— <br /> *11 00 <br /> emoved:•......r•.•,.......,,••..•.•..•r...•••..•. <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil,DBA Rich-Mart Construction <br /> Address: 351 N. Beciunan Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: ( 209) 462-4581 <br /> Authorhed 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: �`c'l� Z� Title: Vice-President <br /> J-0 <br /> SFUHON 4 - To be lsiigned and ad�ated by an authorized representative of the treatment, storage, or disposal facility <br /> Tank is free�itf gaj�s�udgeglpa"f1 hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City:Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 1 985-4810 <br /> Date Tank Received: <br /> Signature: Title: IG�e7.�f r/ds <br /> ...,.......rr•u•••,••r,••,ru,rr•r••••rr•••,u•••••••u•,,,•,•u••r,••,r•••u,•,••••„•,u,r,u•,•u,•• <br /> ER 23 049 (Revised 7-10-92) page 10 <br />