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PARC PIEAEM SEWICES I? l <br /> SAN JOAQUIN COUNTY ?i <br /> JO(J KNANNA M O.,M.P.N. <br /> Irahh Olfiar ' <br /> P.O. 11ox 2009 • (1001 East Ilazclton Avrnue) • Stockton, California 95201 <br /> (209) 468-3400 <br /> UNDERGROUNDTANK DISPOSITION TRACKING RLCOICO <br /> SECI ION I - Piddle I leallh Services 'I racking Sheet will accompany each lank affixed with Its site Identification number. lire <br /> 'I acking Sileet Is to be returned to Public I Icalth Service-% willrb0a dgya of acceptance of the lank by lire disposal or recycling <br /> facility. the pennll holder Is responsible for ensuring that this form Is completed and returned. <br /> r-ACILII'Y IJAME: Mohammed Malik <br /> FACILITY ADDRESS:CA 6550 E. Highway 12, Lodi, CA 95240 <br /> 'TANK II) N39 - 001 Tank Description: 200 gallon <br /> •.r•••••••rrr�•rr•••••u•••••••••r•••••rv•••••••r•r•••••••r••rrrr•••rr•••rr•r•r•r•••••••••••..••�•••r••••• <br /> Sf?CITON 2 - To be filled out by lank removal contractor. <br /> lank Removal Contractor: JIM TIIORPE OIL, INC. DBA RICII-MART CONSTR. <br /> Address 351 N. Beckman Rd. , 11. 0. Box 357 City: Lodi , CA Zip: 95241 -0357 <br /> Phone 2l: ( 209 ) 368-6175 Dale Tank Removed: 1/8/97 <br /> •rr•••r••r••••••••••••r••••r•••rr•r••••.r•••••••r•r•r••r••a••rr•••r••••••••••••r Nr••••.•N•••••••••••••r• ' <br /> SRCI ION 3 - to he filled out by cnoiracior "decontandnathrg tank": <br /> 'lank Decontamination Contractor: JIM THORPE OIL, INC. DBA RICII-MART CONSTR./Nor-Cal Oil , <br /> hauler of r nsate <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City. Lodi , CA Zip: 95241-0357 <br /> Phone N: (___?09J 368-6175 <br /> Aulhorized representative o tonlrac or ce Illicit by signing below that the lank has been deconlandnaled In an approved <br /> manner as requlre a tale I I lealUs Services. <br /> Slgnahne -Title: President <br /> . •• •• •• •••••• •r ••• • ••a•••• ••••a r•• awr•vapor••••• n • r•••••• ••• • •••••••••r••• •••••r•• <br /> rank 1N tree e i all and daes ly all rydrocarion vapors upon treatment, oo ee, oiridiszer Steill� . <br /> SECI40N 4 - '1'o he signed and dalerl Iry an nulhorized reprexer tnllve o the treatrnenl, storage, or disposal Fac ty <br /> accepting lank and/or piping. <br /> pnclllly Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordo Zip: 95742 <br /> rllone b': ( 916 ) 985-4810 <br /> Dale lank Received: <br /> ' Signature: � � Title: <br /> Page 10 <br /> Ea 21 069 (Rev 2/9/911 WP <br /> ' d Uldilnn o/S.n)mquln Cnunry Ilohh U¢ScMca �) <br />