Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> #+##iiiw###iw##+w#iwfii##fiw##w#4#iww#fifiw##iww44iww###ww#w##fii####wifi##w4+w#+##w4ww#4w4#4#w#:#fiww#+#4fiw4#fiw44 <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: Zoya 0. Bryner E.P.A. # CAC 000768648 <br /> FACILITY ADDRESS: 764 E. Hazelton St. , Stockton, CA 95203 <br /> TANK ID k39 - J`O(D 93(o TANK SIZE: 1 ,000 gallOPREVIOUS TANK CONTENTS: gasoline <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil, Inc. <br /> Address: P.O. Box 357 City: �L�odi, CA q Zip: 95241 <br /> Phone #: ( 209 ) 368-6175 Date Tank Removed: Nil <br /> #######+###i*w##twwww##iwww#rt+www#rt#i+fi##4wwww##ii4ww#fiww##fiwi####w###4+#ww#*iww##wwwM;wwwrtiww##fiww#4fifiww## <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: City.351 N. Beckman Rd. , Ci Lodi, CA Zip' 95240 <br /> Phone a: ( 204_) 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 Cal EPA. yet <br /> Name: �iryt31th I t�Da-OP_ Title: �2EJ signature:L� y Date / vtweF-j91 N17 <br /> i ## #www*1#+iq#####w ####+ #4 fii w ##w+ww# + ww +#++# w4#+rwrt#+#+ww*4#+ww w aww#rwy++ #+ 4 +#w #+## wM <br /> Ta C BNpd - o be signeedeand dated�byS nU authorized representative se tad a of the t0reeatmrs ent,storraege, or disposal facility <br /> zer eel . <br /> O accepting tank and/or piping. <br /> Facility Name: <br /> Schnitzer Steel Products <br /> 12000 Folsom Blvd. Rancte Cordova, CA 95742 <br /> Address: Ity: Zip: <br /> Phone N: ( 209 ) 985-4810 `�/G <br /> Date Tank Received: � /, <br /> Name: Title: Signa Date_ l <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />