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REMOVAL_2003
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0521727
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REMOVAL_2003
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Entry Properties
Last modified
9/25/2019 9:18:39 AM
Creation date
11/2/2018 9:31:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2003
RECORD_ID
PR0521727
PE
2381
FACILITY_ID
FA0014756
FACILITY_NAME
TONY JOCKOVICH TRUST
STREET_NUMBER
767
Direction
N
STREET_NAME
ALPINE
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
10126038
CURRENT_STATUS
02
SITE_LOCATION
767 N ALPINE RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\A\ALPINE\767\PR0521727\REMOVAL 2003.PDF
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EHD - Public
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SAV JOAQLZti COL-NTY PLBLIC HEALTH S�VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> LN- MERGROUND STORAGE TANK DISPOSITION TRACIaNG RECORD <br /> SECTION 1-Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> this form is completed and returned. <br /> FACILITY NAME: Tony Jockovich Trust <br /> FACILITY ADDRESS: 767 N. Alpine Rd. , Stockton, CA 95215 <br /> TANK ID 939- TANK SIZE: 350 PREVIOUS TANK CONTENTS: Unleaded gas <br /> - *#WW#i*W%###%iWWW%%W#W#%#WWW#ixLtKiL1LW.ElW##hWWW#*#W##WW*W#%*WW#%#WW*#WW**WWW#WWWWWWWWW######WW#%**###a:xW*#W }} <br /> SECTION 2-To be filled out by tank removal contractor: <br /> TankRemoval-Contractor: JIM THORPE OIL, INC. -Address:-677 E. Lockeford St. P. 0. Box 357 City: i odi CA Zip: 95241-0357 <br /> Phone#: (209 ) 368-6175 Date Tank Removed: 3 <br /> SECTION 3-To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address: 677 E. Lockeford St. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone X: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by <br /> Cal EPA. <br /> Name: /Ylan/1 l/lsn Tide: �d t re Z� <br /> Signature: Da <br /> i W%*WW %###WW * *W *#:W#}WW#*W s* <br /> Tan1�[ Is free o "�W s ldu�ge� ani uln roc rbon va�lgrs ��or} de��Xer 'A- <br /> re <br /> SECTION 4-To be stgrted an by an au horue represen a the o e rea t, s r ac t <br /> accepting tank and/or piping. <br /> FacilirylYame: Schnitzer Steel Products <br /> Rancho Cordova , CA <br /> Address: 12000 Folsom Blvd. City Zip: 95742 — <br /> Phone X: ( 916 ) 985-4810 <br /> Date Tank Received: 7 O� <br /> Name: <br /> Signamre: Date ?/^ <br /> Page 10 <br /> EH 23 046 (Revised 08113/99) <br />
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