Laserfiche WebLink
SAN JOAQTJIN LOC!A_T" HEALTH DISTRICT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> xx**xxxxx********x***x*x**x*x***xxx**x****x***x*xx****xx*x*xxx*x*************x********x**xx <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 District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. The holder of the permit with number noted below is responsible for <br /> ensuring that this form is completed and returned <br /> FACILITY NAME: John Kautz Farms <br /> FACILITY ADDRESS: 5920E Live Oak Road Lodi CA <br /> TANK ID #39- - Exempt Fuel Storage TAnk / -3 060 GAS.Taou(L <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL INC. <br /> Address: 351 N Beckman Road Lodi CA Zip: 95240 <br /> Phone#: (209 462-4581 <br /> Telephone: ( ) Date Tank Removed: 3/14/89 <br /> *xxx******x******xx*xxxx**xx**xxxxxxx******x*x***x***xxx*x*xx*x*x*xxx***x*x*************x** <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Hauler of Rinsate <br /> Address: 807 E. Black Diamond, Lodi , CA Zip: 95240 <br /> Phone#: (209 462-4581 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved mann as may be regulated by Department of Health Services. <br /> Vice-President <br /> SIGNA D TITLE <br /> x*xxxxxxx**x*x*x****xxxx**x*x****xx*x***xx*x***x**x*x*x*xxxx**xxx*xx***xx*xx**x*x**xx*x**xx <br /> SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name SCHNTZER STEEL PRODUCTS CO. <br /> RANCHO CORDOVA, CA 95742 <br /> Address: 916.985.4810 Zip: <br /> Phone#: <br /> Date Tank Received: <br /> AUTHORIZED SIGNATURE AND TITLE <br /> Eli 23 049 12188 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOC'KTON, CA 95202 <br />