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`. <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SE CES;1+l <br />ENVIRONMENTAL HEALTH DIVISION'' <br />UNDERGROUND STORAGE TANK DISPOSITION TRACgl tG RECORD 35 <br />n3 OCT 14 <br />ivisio Tank <br />Sheet shall accompany each tank afftxed with <br />SECTION 1 - Public Health Services <br />Environmental Health Division Tank Tracking <br />lic Health Services Environmental Health Division <br />its site identification number. The Tank Tracking Sheet is to be returned to Pub <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 <br />The City of Stockto <br />FACILITY ADDRESS: 428 E. Fremont St. <br />TANK ID #39 - 05J 507 TANK SIZE: 500? PREVIOUS TANK CONTENTS: Diesel Fuel <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thorpe Oil, Inc. <br />P.O. Box 357 <br />City: Lodi, CA <br />Zip: ( 5241-0357 <br />Phone #: ( 209 ) 368-6175 Date Tank Removed:_T <br />n*re**nn*r***H+H**r**nn+nH*nr*eH*rn*nr*nH***nn*rH*nn*r*nHrnH*r*n*nHrn*nrrn**n*nn**n******+n**n*+n**rnr*nH** <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br />P.O. Box 357 <br />Phone #: ( 209) 368-61 <br />City: Lodi, CA Zip: 95241-0357 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br />manner as required by Cal EPA. <br />Name: L}�- Title: Signature LDr1 Date <br />o....... --------- <br />4 f W Re sfiigoc la dgkbl' <br />accepting tank and/or piping. <br />h 19,Tientt'?;T6% Schnitzer <br />FacilityName: <br />Rancho Cordova, CA 95742 <br />12000 Folsom Blvd. City: Zip: <br />Phone #: <br />o,F. QRS -akin <br />Date Tank Received: — <br />Name: Wl," r7 S Title: (U M al/ Signature: Date <br />H**rH**rnH*rrHr*nn*rrnr*rnr**rrn*nrH*nnrrnr*nr*HrHnrnr*nnrrrrrnr*++*n+++nH*+rnr+**n+err++err+**rnHHrnrrrr <br />EH 23 046 (Revised 08/13/99) Page 10 <br />