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• :5.8►N .7R�AQ0'SN LOG.2AI.. H�31—T•TH �I13�'EZIC'l' <br /> UNDKRGROUW TAN( DISPosITION TRAcKma RT900RD <br /> p!l09RRt!!Rl1ttRRRRR!!t!*!t#tatlt*}RRxRtiR**iRttt*!#RtRttttttfltYlARRtl11AtRRltR!!!RtlRA!!!!t!R <br /> fTIMION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> affla�d with Its site Identification. number. The Tracking Sheet is to be returned to San <br /> 4oaquin Local health District within 30 days of acceptance of the tank by disposal or <br /> rxycling facility. The holder of tbq prnit with nor nodi flow is re 2gpgjb % for <br /> +gam that this fore is comnletW and rsturned. <br /> FACILI'T'Y NAME: Puregro Comnany <br /> V=WTY AD S:_1904 W. Charter Way. Stockton,,, CA_ _ _ <br /> EPA Site #CAD 009109844 <br /> TANK ID 139- 1 - 1 ,000 gallon unleaded gas tank <br /> tR*tRtt*R#R***RRlfxt#!tx*fRx***A#ARt*RR}RR*tRRtRR*tit}YRRiR*tt#*Rt*#flttRRltRRlAlR*t!t!!!R!R <br /> PION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM 1'HORPE OIL, INC. <br /> Address; 351 N. Geckman Road, Lodi , CA 91,240 <br /> �_— Phonel: (10917-687717- <br /> Telephone: <br /> 109 :s68- 1Telephone: ( ) ___Date Tank Removed:_!�� <br /> RA'SRtttR*RRRRR*RR#RRfRYRRRRR*RRxtRR}RR#*RRRRRtR*RR!*xRtR#RRtlRlRRRtlAltt!#RtxttttR!lRtRltt! <br /> <'-A8CYION 3 -To be filled out by contractor "decontaminating tank": <br /> 'i 'TW* Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Mauler o` rinsate <br /> 351 N. Beckman. Road, Lodi , CA Zip: 95240 <br /> Phone#: (209) 368-6 75 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> docantaminated in an approved manner as may be regulated by Department of Health Services. <br /> ice-President <br /> SIGNATURE ANWfIITLE <br /> !!#!*RRlRRRt*RRRRR}RRRYtRRtRRR*t*R**t T(**}xR}**xRRRt*}*RBBB*#f.iRR}R#**RtRRRR*RR*Y}x}**R*Rtt <br /> !AR-TION ! - To be filled out and signed by an autnorized represnetative of the treatment, <br /> atormp, or disposal facility accepting tank. <br /> SCHNITZER STEEL PRODUCTS CO <br /> M BLVD. <br /> FaBr <br /> cility Name 12000 FOLSO <br /> p_p57C2 <br /> RAN 91 — — <br /> Jkklreas: <br /> Phone#: <br /> Date Tank Received <br /> HORIZE� SIGNATUKE AND TITLE _ <br /> -.AR1tlt*tRRRR*RR*RR*R**tR##!Rt#RRRRttRRRdRR*#}RAR RtiRRRltRRt#RRRRtRtt#R!tlRR#RRt#tR#Rt!!!t! <br /> T41� 2.3 a�9 I2ie# <br /> bil LINU INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTA!;R. <br /> SAN JOAQUIN LOCAL HEALTH DISTRTCP <br /> ATTN: UNDERG R(A.)ND TANK PROGRAM <br /> P. O. BOX 2009 <br /> STOCKTON, CA 95202 <br />