Laserfiche WebLink
PUBIC HEALTH SIJVICES <br />SAN JOAQUIN(OUNIY <br />JOGI KHANNA hi.D., MT 11. <br />Ilnllh OIIi(zr <br />P.O. Box 2009 • (1601 East Ilazclton Avenue) • Stockton, California 95201 <br />(209) 468 3400 <br />UNDERGROUND TANK DISPOSITION TRACKING RECORD <br />•44 r44rrr•r••r•jr 44rrrr•rrrrrrr♦••rrr rr•4rr4r••••rr •r ♦•rrr••rrrrr 00000 r4r••r•�r 4.0444444••4 rr•r4u44r4.4 r4• <br />SECTION 1 - Public flealih Services Tracking Sheet will accompany each lank affixed with Its site identification number. The <br />Tracking Sheet Is to be returned to Public I lealth Services within 30 du of acceptance of the lank by the disposal or recycling <br />facility. The permit holder Is respon4lbie for ensuring that (his form Is completed and returned. r� <br />FACILITY NAME: FRANK HOGGE EPA SITE #G/¢&©COQ/% <br />FACILITY ADDRESS: <br />12889 E. Locke Road, Lockeford, CA 95237 <br />TANK ID #39 - N/A Tank Description: 1 EXEMPT 1,000 gallon gasoline tank <br />SECTION 2 - To be filled out by lank removal contractor: <br />Tank Removal Contractor: tank removed by owner - same as above <br />Address: <br />Phone #: <br />City: <br />Zip: <br />Date Tank Removed: February 3, 1997 <br />•44•••••444.4••••r•ur••••r•4rrr••••♦••••♦••••••••♦••♦4044•••••••4•♦44•••44••••i••••••••••r•••••••••••••••r <br />SECTION 3 - to be filled out by contractor *decontaminating lank": tank dry iced, triple rinsed & picked up by <br />Tank Decontamination Contractor: JIM THORPE OIL INC. DBA RICH -MART CONSTRUCTION/Nor-Cal Oil <br />on February 3, 1997 Hauler of rinsate <br />Address: 351 N. Beckman Road City. Lodi, CA Zip: 95240 <br />Phone #: <br />Authorized representative of contractor certified by signing below that the tank has been decontaminated In an approved <br />manner as required by the Slate Department of fieallh Services. <br />Signature: <br />Vice -President <br />••• •••44w4••••4•• 0400•• •`♦• •• rr •4u♦♦•r •• uu•• •40 ••4.4rrr♦rr44444 ♦ 00.000• ••r 0040.0444♦• 4400 <br />Tank and 1 ping are Tree o aii siudges and10hyrocarbon vapors uppon d♦efivery �o V' nitzer �tee1. <br />SECTION 4 - To be signed and dated by an authorized' representative of the treatment, storage, or disposal facility <br />accepting tank and/or piping. <br />Facility Name: SCHNTT7FR CTFFI PgnniIfTS <br />Address: <br />12000 Folsom Blvd. <br />Phone #:(916 985-4810 <br />7 <br />Date Tank Received: e / / _ c -h j <br />1,; <br />City:Rancho Cordova zip: 95742 <br />04000♦4444•♦••••4•••4♦•0•••••004 <br />Page 10 <br />Ea 23 049 (Rev 2/8/91) up <br />A D14sion of San Joaquin County Iloith Care Servlca O <br />