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SAN J01ftffIIN COUNTY rUDLIC HEALTH SERVIn.,o <br />FNVIRONMF,NTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSPITON TRACKING RECORD <br />....a.♦««♦«««w«ar+####+r###wr#«#+#♦r+#+#+#•r#�#+#+#rr#w«#####r#rr###rr+i##rr#rrr#!r#rlrrrrrrrglr4NlNlMr <br />SECTION (- Public health Services Fnvhnnmcntnt llcalth Division Tank Tracking Sheet shall accompany each tank affixed <br />with it.e sire irlcnrification number. the 1"auk Tracking Sheet is to he returned to Public Health Services Environmental Health <br />Divh1fin nitldq JQ dnvs of arcrptance of fire tank by the disposal or recycling facility. The penult holder is responsible for <br />cnsuring that this form is completed and returned. <br />'M:ILRY NAME:_" Ralph-ia-11arkeL_— G P A li CAC n--- Ath <br />rncD.N Y ADDRESS: 2122 S. Airport Way, Stockton, CA 95206 <br />TANK ID p19 1"ANK SI7F_: 12,000 galsPREViOUS TANK CONTENTS: <br />gasoline <br />......... h. aw• a.+ a♦.a-#H#w♦+wHw#44♦++w#H+##f#♦ff#w++♦#MN#H♦++M♦##+♦!r♦#f♦r Mr#r#!#rffrrr##r#r####rrr <br />9FC'IION 2 - to be filled out by look removal contractor: <br />lank Removal Cnatractor. Jim <br />lrfc. <br />Addtcss: 351 N. Beckman Rd./l'.0. Dox 357 City: Lodir CAG zip: 95241-0357 <br />floor. A: (209—)-368-6 Date Tank Removed: <br />...... 4+4+ ... H ai+• ay ww ♦+++++++#++++♦##+w #♦++++##+# #++++++++#+++#+Mfr!+## # ♦+# # «+w M } # • M+#+++#+#+++# ♦!+• M <br />SECTION 3 - "10 be filled out by contractor "decon(nmina(Ing lank": . <br />lank Decrnnatrhro(lon Contractor: Jim Thorpe Oilr lnc. <br />Address: 351 N. Deckutan Rd./P.O. Dox <br />Phone p: (--2.09 ) 368-61 <br />City: Lodir CA zip;95241-0357 <br />Anthmizrd rrpfrVololive of contractor certifying through signature below that the intik has been decontaminated in an approved <br />mauler as required by Cal EPA. <br />riane:_�Y1�,++1w—f1wr��P Title: ��� Signatur�i Bete l0%�R <br />laqk is free o1 af( s ges an <br />SEF -ZION 4 - "ro be signed and dated by an <br />accepting tank and/or piping. <br />racility Name: ScImUzer Steel Prrxhacts <br />Address <br />12090 Rolsomt Blvd - <br />phone I. ( 916 ) 985-118 10 -- <br />Date rack R ved: <br />plane: _ Title: <br />«IHN«♦Vii Mr3w «r MH#M#+M+ww♦#«aw <br />E11 21 M6 (Revised 9/11/96) <br />a.#+a.+aa+aa♦ <br />Paps 10 <br />Rancho Cordovan CA <br />City: zip: 95742 <br />r#r#Mr#rr4♦rr+rMrrr#rrlfrr►rrlrrr! <br />