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PUBIC HEALTH SEI PCES <br /> A <br /> SAN JOAQUIN COUNTY r. Z <br /> r. a <br /> JOGI KHANNA M.U.,M.P.N. " f <br /> Health Officer <br /> P.O. Dox 2009 • (1601 East Ilazelton Avenue) • Stockton, Califomla 95201 rd<'frf'd�s� <br /> (209) 468 34o0 <br /> UNDERGROUND 'TANK DISPOSITION TRACKING RE'C'ORD <br /> •.•1.Irl.••••1.r1111r•1•I1rr••rI•IIIr•I•Irl•Rr1r•f•••••RrrfRrr••Irr•rRRr••!•1I1fr Rrl Rl rsr••r1!•r•rrf rrr l.fr <br /> SF.,CIION I - Public I lealdt Services 'Tracking Sheet will accompany each tank affixed with its site Identification number. The <br /> Tracking Sheet is to he returned to Public I leallh Services n (Idj 30 days of acceptance of the lank by the disposal or recycling <br /> facility. 'I he Permit holder is responsible for ensuring that this form Is completed and returned. <br /> FACILITY NAME: HEUBLEIN WINES <br /> FACILIlYADDRESS: 21801 Hwy 120, Escalon , CA 95320 <br /> 'TANK ID #39 - NSA Tank Description: EXEMPT 1-550 Heating oil tank <br /> •.r••I111rr11••I.1.1rrr•11111rrI••••RRrr••I••I••rllrr•11I!•rr1.lrrrr•11IrIr1rlrrrfrrrrflr!!r!r••urrrrlrrl <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. DBA RICII-MART CONSTR. <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 Date Tank Removed: /�2 e//?Z <br /> IIIIr•111.11•I.1.11rI••Irrlll•IrR•r•f•I••lrrrlf••f•rff•r••lf rrlr!•f rlr!!r! rrffr!!!r•lf rrrlrrr rrllrrrrff!!• <br /> SF"ION 3 - to be filled out by contractor "decontaminating lank": <br /> Tank Decontamination Contractor: JIM THORPE OIL, INC. DBA RICH-MART CONSTR /Nor-Cal Oil <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 Hauler of rinsate <br /> City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized representative of contractor certified by signing below that Ihe lank has been decontaminated in an approved <br /> manner as required by the State Department of f lealth Services. <br /> Signature: — I r `C" Title: Vice-President <br /> I• rltrl 1r1rr• •I 11 11•I•r11r !R 1•rrrl IRr!•r••1�rf 11lrllR <br /> Yank is free e s ail and dated and"hydrocarbon vapors upon delivery" �"""""""ee"ee!!""•"' <br /> SECIlON 4 - To accepting <br /> signed and dated by an authorized representative of the treatment, storage, or disposal facillly <br /> acccpUng lank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordo vZip: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Rec ed: <br /> Signature: <br /> Title: <br /> 1.111••I I♦NIHI•I I•••!M•1.111•••!•R••If•INfrlN•r11I1.1lNrI•rI1Ilr IlIM1!•-!l NrNHlMlN1f•!!rMl MY <br /> Page 10 <br /> EN I7 069 (Rev 2/8/91) WP <br /> A 010.0nn or Sul Jnlpuln emmty nealih Cue scrdce., �', <br />