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.• ,,,� $AN JOrA�JIN LOCl1L FiFAI'�T�DISTRICT <br /> 1 UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> RRi!lRtttRlttRRltti!!tt*tR*R*RiRli*!#ttt**t*!tlRtt!!tt*t**t!#ttR##***RR*tR!!t!R*t!!*!!t##** <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: Spear Manufacturing <br /> FACILITY ADDRESS: 4350 N. Newton Road Stockton CA <br /> TANK ID 139- - 0 _ 1-1 ,000 gal. unleaded gas tank EPAIk: CAD 981457971 <br /> #RR**t*****RR**R!#tR**R*tR#t**RRtR*RBBB**RRRlRRtRRttR*RR*R*R*R*#*R*RR**RR*RRRtRi**#ttR*#RRR <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 95240 <br /> Phone#: ((2 3� 68-6175 <br /> Telephone: ( ) Date Tank Removed: _14?1;z9l9y <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> Address: 351 N. Beckman Road , Lodi , CA Zip: 95240 <br /> Phone#: (209 368-6175 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> `��'1 ./J Zx ✓fZ��i>Y___ Vice-President <br /> SIG1qATURE AND TITLE <br /> **********R***ttR!lRttRtRRR**R*t*R*RtR#RRR***RRR***t***R*RR*RRRR*Rt**RR*Rt***************!# <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 efRCL <br /> C ;; c <br /> 12000 FOLSOFA BLVD. <br /> Address: RANCHO CORDOVA, CA os7c, Zip: <br /> Phone#: <br /> Date Tank Received: <br /> uY t_ �] <br /> AUTHORIZED SIGNATURE AND TITLE <br /> CH 23 019 12/88 <br /> NAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. q� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 OCT 41990 <br /> I PONNIENTAL HEALTf <br />