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SAN JC AC N LOCAL I-roju,THaI STE2I= <br /> UNDERGROUND TANK DISPOSITION TRACKING REOORD <br /> tttttt!!tRltltRlR*t!#!R!#!*R*k*t#t#ttRRRkkRlR#!R*RRRt*kRkA#R#tR*RRR*#RkRRlR#R*RR*!##RRtRRtt <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 Sari <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 nimt_r noted belay Is responsible for <br /> ansurina that this fore is completed and returned <br /> FACILITY NAME: Alves and Perry <br /> FACILITY ADDRESS: 18700 Tom Paine Road , Tracy, CA <br /> TANK ID 039- - EPA Site # - Exempt Underground Storage Tank <br /> !t!R!ltRR!*R,r**kt**k*kk*!R!t**RR!##RR*tk##t#**#*kRRR**#*RR*R!R#RRR#R!R#RRRIR*tRRRRtRR!ltlRR <br /> 8WrION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: ,'IM THORPE OIL, INC. <br /> Address: 351 N. Beckman Road, L.odi , CA 95240 <br /> Phone#: (2 3611_6175 <br /> Telephone: ( ) _Date Tank Removed: 8/2/89 <br /> tARRt!lRRtlttR*k**k#R#RltRltt#*!#**k*RR******Rtt**#*#t##!tR#RR#k#!###RR*RBBB##tRRRlRRlR!!R! <br /> 88CTION 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. Beckeian Road , Lodi , CA Zip: 95240 <br /> Phone#: <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontasinated in an approved manner as may be regulated by Department of Health Services. <br /> 7n Vice-Presider' <br /> SIGdATVRE AND TI fLF: <br /> !!lRRRRlRR*Rttkt*ktRtRR!##RR****ktkkR*RtR*kRkRtR#*RR*k*Rtkk**k Rhkk R**kR#tRkR***ttR***R***tt <br /> OWTION 4 - To be filled out and signed by an authorized represr*,tative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Fecilit Name C�'.ivn7ER STEEL PRODUCTS CO <br /> Y _ 12OCO FOISOP.� BLVD. <br /> Address: e i 'i o., <br /> _21p: _-- --- <br /> _Phone#: <br /> Date Tank Received:_ — <br /> AVfHORIZED SIGNAAM AND TI'IT,E I <br /> Rt*#RlRR!!#tRR*!k*Rf#tRtRRltlk*t*tRR#*!R!#R*RR!!*RlRRRRRR#tt#R!lRRR�t!#R*tRR!!RlRt R#!tRlRRR! <br /> CH 23 049 12/88 <br /> MAILING INSTRLICTICKS: F Z IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCCICIN, CA 95202 <br />