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$AN JOWLJSN LOCM- t. MA1-V r>18U R3:4ZT <br /> UMma;OIM TAMC DISPOSITION TRACKING RECORD <br /> ###t#!ff#RlttRRRRf*lRRRiR*RR*R#RRtRRRRR*R**RBBB!RRRR*lRRR*RRRRR#RR!*RRR#!#!!f#f##iR#RR#RBBB <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 thz ce1111t with number note below is resoorslble for <br /> ensuring that this form !s completed and ret_aned, <br /> FACILITY NAME:C. T. Brayton and Sons <br /> FACILITY ADDRESS: 1745 Second St. Escalon, Calif. 95320 <br /> TANK ID 139- �� �h - 1-550 gal. Diesel Tank rR Otgf 1 CA <br /> #*RBBB*RRR#**R*R!##RRRRRRR!***R#RRRRR*RR*RRRRRR*RRR#*RBBB*RRR**RRR*RRRlRR*RR*!!!*RRlRlRR!!f <br /> sWrION - 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 /> Phonef: (2 368-6175 <br /> Telephone: ( ,c)_) ora r,175 Date Tank Removed: <br /> fRR#RBBB*RRRRR#*#R***RRRRRR**#R*#***RR***RR**RR*RBBB**RBBB!RRR#*RRlRR!*!!R!*R#i*R!lRRtR!!!R <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIP1 THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> Address: 351 N. Beckman Road , Lodi , CA Zip: 95240 <br /> Phonel: (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 /> Vice-President <br /> .�7j SIGNATURE AND TITLE <br /> *#*R*#**R*R*RBBB*R!R*##*RR**R**RRR**RBBB**RRRRR*R*!R**RBBB****RRR*R**RRR*RR***R*tRRRR*R**!R <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 <br /> SCHNIiZER STEEL PRODUCTS CU <br /> 12000 FOLSOM BLVD. <br /> Address: __ Zip: <br /> ��F1n9UA C^ 05742 <br /> 916-985-4810 Phone A: <br /> Date Tank Received: <br /> AVCiIORIZED SIGNATURE AND TITLE <br /> RRlRRlRRRRRRRR*RRRlRRlRRR!lRRR*RRR***RRRRRRR**RR##!**RRRRRR*Rft l ltR RfIRlRRlRRRlRRRRR!!lRRRRRlR <br /> EH 23 049 11/81 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERMOUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCK'PON, CA 95202 <br />