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SAN JO: VI N LOCAZ, HEAL•I DI S'I'E2I CT <br />xrxxxrrr*R**rx*rRe*r*rwxR*RxxrR*wxxwxw***w*xxx*xx**xwwRw**xrxrwRRx*ww*RR*R*R***wR*rR***rxrx <br />SECTION 1 - The San Joaquin Local 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 Dfstrict within 30 days of acceptance of the tank by disposal or <br />recycling facility. The holder of the oernit with number noted below is re5Donsible for <br />ensuring that this o s +s l�eted and returned, <br />FACILITY NAME: Panella Trucking <br />FACILITY ADDRESS: 2150 E. Fremont Street, Stockton EPA Site # CAC 000159381 <br />TANK ID 139- %/% %% - '' Jy,� 6 , <br />x*rrRx*RR*xRw**RxRrxx*xX**xx*Rwrxxr**xR**wR***RRwr*x*xRRww**xRR*R* Ow*x x*RwR*x*Rc*e*wx*w* <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thorpe Oil, Inc. <br />Address: <br />351 N. Beckman Road <br />t: <br />ip: 95210 <br />Telephone: ( 209 ) 462-4581 Date Tank Removed: �oI /3 ski <br />**********■**t********t******************x*r*xxwRr*RRR*w**xw*wxwR*wxww****rx*w****Rxwrxwxrx <br />83LTI0N 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: Jim Thorny Oil. _Inc./Nor-Cal Hauler of Rinsate <br />Address: 807 F Black Diamond Lodi CA Zip: 95240 <br />Phone/: (26 j76i7-4Wr <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in an approveg manne;_aa mabe regulated by Department of Health Services. <br />' SIGNATURE AND TITLE. <br />** *********************w*X*x*x*xw*RX*w*RRR**Rww*RX*R***RX***R****R***R*** <br />SECTION 4 - �To filled out and signed by an authorized represnetative of the treatment, <br />storage, or disposal facility acceptir)g tank. <br />Facility Name <br />Address: Mandeville Island, Stockton, CA Zip <br />_ Contact Rov Godfrey Phonet: (209 464-2959 <br />Date Tank Received: 6/16/89 <br />A IZED 3IGNATU <br />rwRw*w**wxrR*wxxx*rxR*xrRxxrrww****r*rxxxxxx*wR* <br />LH 23 049 12188 <br />NAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. <br />Rw*Rw*RwRw**RR****x*RR*RwRRRRRwRXw*R*r <br />AFFIX PROPER POSTAGE. <br />SAN JOAOUIN LOCAL HEALTH DISTRICT <br />ATTN: UNDERGROUND TANK PROGRAM <br />P. O. BOX 2009 <br />STOCKTON, CA 95202 <br />