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SAN JOAQUVi COLNTY PUBLIC HEALTH SERVICES <br /> ENVrR0IG3IENTAL HEALTH DIVISION <br /> VNI)ERGROUND STORAGE TANS DISPOSITION TRACKING RECORD <br /> nT#.,WWWivwYIWWWW VifYWW'M##YYi}Ylti#####iWifx#f#i#WW1?1x14.SYYWWYY!rtVnx.wTWWiW+YWW«wYi»WYWWWiW WWWi YYziza <br /> SECTION 1 -Public Health Services Environmental Hcalth Division Tank Tracking Sheet shall a:compeny each tank affmmd wit.". <br /> its site.dentiflcation number. :'h:Tank Tracking Shat is to be returned to Public Health Services Environmental Health Di%tsicc <br /> wet of acceptance of the tamp by the disposal or recycling taclliry. The permit holder is responsible for rsuring test <br /> this form is completed and reraned. <br /> ?AGILITY NAME: <br /> The City of Stockton <br /> FACILITYADDRESS: he right of way adjacent to 333 N. Hunter St . , Stockton , CA <br /> 500 gallonsleaded gasoline <br /> -ANK ID #39.J O I S$7!o TANK SIZE: PREVIOUS TANK CoN-Tr-N'TS. <br /> •ixwwxxW WYYi»xWWWWiY! WW #WW»WYW iW iW YWWiix WiWYW#WY#W WWWW WWWxY###WW»xwxWY»YWi}}YWTIWx»»:nYWW«z WYT Yww Wei W.w <br /> SECTION 2-To be filled out by tank removal cortttactor: <br /> TnnkRemcvalCaruriemr JIM Thorpe Oil , Inc. <br /> Address: P.O. Box 357 City: Lodi , Zip: 95241-0357 <br /> ?hone R: ( 209 ) 368-6175 Date Tamk Removed: <br /> wYiYWYzifMYiWW#ixRalflYR»a}Tpx#YW.wfT#«YW WWWWYWYW WTrw WMY4YZWiwYWYWW Y+,WYWWWiW WYiaiYWifT}iWWWWYz}Wit WizzxW#Wa <br /> SECTION 3 -To be fled out by contmaor"decontaminating tank": <br /> Tank Decontamination Coatraetof: Jim Thorpe Oil , Inc. <br /> .address: P.O. Box 357 Cly, Lodi, ZiD:9524 -03517 <br /> Phone p; ( 209 ) 368-6175 <br /> Autbori ed representative of contractor certifying through signature below t`at the task.,=bran decontaminimd in an approved <br /> man,ner as required by Cal EPA. <br /> Name: <br /> Tibet Signature: Date <br /> WWWYxiz#Wy WWYiWV#W»yiiWYWWW}#WiikW#W!#i##W«wYYi.«i Y#Www....Y>«.WWWWifvYW izW wYlti##ixiYWWWYWx###Wi##Y}YixiiWi• <br /> SECTION 4-To be sigaed are dated by an autborkcd repriscntative of the treatment, storage, or disposal facility <br /> accepting Lark and/or piling. <br /> Fac iry NaMC Schnitzer Steel Products <br /> Ranch ) Corclova, UA 85742 <br /> Address: 12000 Folsom Blvd. City: ZIP: <br /> 916 985-4810 <br /> Fhone : (_J <br /> Date Tank Rsceived: <br /> Ndnte: <br /> Titl': eignarsre: Dam <br /> L T.•W:zfx YZYYWiY YYYW»1e14 W+,W i WWiWi#aaxw IWYY WY W..TWty�y Y}WT•'.'«n»ai W WYxWYW}Yub YYYW}....Wi}}Y.W illi WY WiYzynrvYWziY <br /> EH 33 046 (Revised 08113!99) Page 10 <br />