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_ - SAN JU�1Ca.JIN L.0-,SAL Hl~.nr-Tl-l.iDlSZT2IC"T <br /> LMDEIGROL14D TANK DISPOSITION TRACKING REOORD <br /> /tlltttRRflt!lRfef*lftR!!Rx*tx!!RR*!!**xx*R!!fR*RtlA*iRRi*RlttARRi*R*!lRtR**tR}tlttlR}tRl Rf <br /> RWPION 1 - The San Joaquin I.ocal 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, 1tL_holder of the cer:Rit wit►+ n�� -* �� <br /> 11=11"M that this fora is cowl *ed a retWM% <br /> FACILITYNAME: Largin 's Service <br /> FACILITY ADDRESS: 2235 Cherr.kee Rnad Stoc),ton, CA <br /> TAMC ID 139 /s - 0 / '6,0n 0n0 -- -- <br /> t!R!!t!!#!!!t*!*fRltllfytf*t!R#RtRRRRA!!x!**xlRlt,t pRR*RIIR#x*#*!R**R*lRlfR!!!!!*!CAC 000223089 <br /> !!!!*RIRt!!}R <br /> BWTION - 2 - To be filled out by tank removal contractor: <br /> Rank Removal Contractor: JIM ?HORPE OIL INC. <br /> Address: 3L N. 6eckwan Road, Lodi , CA 95240 <br /> --- -� Zip: <br /> Phone#: (2 368-6175 <br /> Ralephonc: ( ) Oate Tank Removed: / kl-AH <br /> !llmR#!t!ltttlt#i#!**!}!Rltt*!!!!#R%!*tltx*RiRft!!!**!!!t*R!!*tRR!!tR!!!!*R!!*ttttRlRtltttt <br /> 0=1,24 3 -To be filled out by contractor "decontaminating tank": <br /> To* Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> Address: 351 N. Beckman Road , Lodi , CA Zip, 95240 <br /> _Phone#: (209 368-6175 <br /> Authorized%dis <br /> tative of ontractor tlfies by signing below that the tank has been <br /> decontaminated y be regulated by Department of Health Services. <br /> Vice-President <br /> 3I AND TITLE 8f1'iION illed out and si by an authorized represnetative of the treatment, <br /> storage, o1 facility accept ng tank. <br /> Facility Nasse <br /> Address: allele LAIGG moo oHo _ zip: <br /> 'Iiaoad <br /> Date Tank Received: <br /> AUTHORIZED SIGN AND TITLE <br /> lAlfLxfRtl4#A!*!!R!t!R}!!AR!#RA!!!!R*!RR*RlAf! tfRt!}}RRRRiRlR*}tAlRRlR!!RRlR}!!!}ftlRRftlf <br /> 88 23 049 12188 <br /> )WLING INSRRl1CSIONS: 1()LD IN HALF AND STAP AFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TAMC PROD M <br /> P. O. BOX 2009 <br /> STOCKTON, CA 95202 <br /> '. , . <br />