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SAN JOA4jkIN LnCAL t ^nr .TF3�IS°I"F2IG"I' <br /> UNDERGROUND TANK DIspos ITION TRACKING RECORD <br /> **RRRff■t*ffffR*RRR*R*R**f#*flRf*RtRRRRlRR*RRlR*RR*flfRRlRRR*RRfi RRtRRRRlf R#fR##RRf#**tftl R* <br /> SWTION 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 *tw_Mmit vit_h nLmher noted below la rgsponsible for <br /> ansurina that this form is completed and return_ <br /> FACILITY NAME: ALVES AND PERRY <br /> FACILITY ADDRESS: 18700 Toni Paine Road , Tracy, CA <br /> TANK ID 839-_ _ - EPA Site #-EXEMPT UNDERGROUND STORAGE TANK <br /> !RlRRRRR*RRtRfiR Rffifi*!!R*t!!***RflRtf RtRRdRRd*RRkRRRfiARkfiRR*Rfi RtRR**R**lRRklRkfi RRR#lRRRltR*R <br /> S®CTION - 2 - To be filled out by tank removal contractor : <br /> Tank Removal Contractor: JIM 1HORPE OIL INC. <br /> Address: 351 N. Beckman Road, Lodi , CA 95240 <br /> Phone0: (2 - 368-6175 <br /> Telephone: ( ) Date Tank Removed: 8/2/89 <br /> **R**R!R*tt!*RRR**tttR#t**R#R****RR*RlRRRR**RRRRRRR*#*f*RlRR#**R***R*RRR*#R#*Rf lRt##R#***!* <br /> OWTION 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#: <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manneras may be regulated by Department of Health Services. <br /> Vice-President. <br /> SIGNATURE AND TITLE <br /> **R!*tR*R*R**!RltfifilR*tttR*RRR**RlRRlRRRRRRkR*R!lRRtfi*RRRkR**tRRR**Rfi RRRR*RtR*RRRRR**RRfi RRR <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 /> SCHNUZER STEEL PRODUCTS GO. <br /> Address: 2000 FOLSOM BLVD. <br /> RAZip. <br /> N <br /> _ Phone#: , <br /> Date Tank Received: <br /> Ti AF____F <br /> AUTHORIZED SIGNATURE AND TITLE <br /> RH 23 049 12/88 <br /> MAILING INSTRU„^TICNS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOQCTON, Ch 95202 <br />