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PUH HEALTH SLI�JICPS ,q.. . . � SAN JOAQUIN COUNTY JOGI KHANNA kI.D.,M.P.II. Ileahh Olficer • r, . �� CO. Dox 2009 a (1601 East Ilazelton Avenue) •Stockton,Ullilmrda 95201 411ird'A� (209) 468-3400 UNDERGROUND TANK DISPOSITION TRACKING RECORD SECTION I - Public I lealth Services'Tracking Slicer will accompany each lank affixed with its she Identification number. 'Ire 'I larking Sheet Is ht he returned to Public I Icaith Service within J0 Jars of acceptance of the lank by the disposal or recycling facility. The permit holder Is responsible for ensuring Utat this form is completed and returned. FACILITY NAME: RICHARD GIAMBRUNO FACILITY ADDRESS: 1101 Argonne Dr. , Stockton, CA 95203 TANK 111 M39 - NSA Tank Description: I - 500 gallon EXEMPT home heating oil tank & piping. SECTION 2 - To be filled out by tank removal contractor. 'lank Removal Contractor: JIM TIIORPE OIL, INC. DBA RICII-MART CONSTR. Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 Phone N: ( 209 ) 368-6175 Date 'Tank Removed: JunO 5, 1995 •,••••.••.••too••••too•.•••••••.•oto•••••••••••••.••••••••••••r•••••••••n••u••••••••••••r•••••u••••••••• SF(:I ION 3 - to be filled out by conlraclor "deconlandnathrg tank": Tank Decontamination Contractor: JIM THORPE OIL, INC DBA RICII-MART CONSTR./Nor-Cal 011 , Hau er of r nsate Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 Phone A: ( 209 ) 368-6175 Authorized representative of contractor cerUfled by signing below dram the tank has been decontaminated In an approved manner as required by the Stale Department of flealth Services. , Signature: 'Itle: V199XPresident Yank is tree or aJi sYu(3ges and'lydrocar6on vapors u�on delivery �o S'cftdid�zer Stele . SECTION 4 - To be signed and dated Try an nothorized represer rntive o the treatment, storage, or sposal fac y accepting tank and/or piping. Facility Name: Schnitzer Steel Products Address: 12000 Folsom Blvd. City: Rancho Cordo Zip: 95742 Phone d: ( 916 ) 985-48 0 Date lank Received: Signature: Title: /I61 .................................................................................•..•.•...•.•.•••••••••.•.. Pagc Ill EM 21 W (Rev 2/8/9t) vp ' A b1.l,tnn o15u,JmmMn Cmmry Ik.nh Carr ScMce, C)