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SAN JOACWN LOC,AI 14F_Ar •TH6PI S-rnI CT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> R**RRIR!#R#R*lttR*x!*x**tx*#tRRtt*t*xxt*t*FRtRttRRtRRtFRxxt**t**tRtx***#*#****RR*#***!Rt*** <br /> SECTION 1 - The San Joaquin Local Health District'a Tracking Sheet will accompany each tank <br /> affixed with its site identification number. The Tracking Sheet is to be returned to San <br /> Joaquin Loral Health District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. The holder of tb!-,_Mmit wig number noted below is repponsible for <br /> ensuring that this form is comoleted and returned. _ <br /> FACILITY NAME: ALVES AND PERRY <br /> FACILITY ADDRESS: 18700 Tom Paine Road, Tracy, CA <br /> TANK ID 139- - _ EPA Site #-EXEMPT UNDERGROUND STORAGE TANK <br /> BDLTION - 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 Zip: <br /> Phone#: (2 3� 68-6175 <br /> Telephone: ( ) Date Tank Removed: 8/2/89 <br /> ***RR#Rx#xt**x****#**x*txlxxxx*#t****R****xtxttt**tRt*t*x**t**t*x*x*****tRRtt*R**t*#tltttRt <br /> SECTION 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 manner as may be regulated by Department of Health Services. <br /> Vice-Pres idem: <br /> J� SIGNATURE AND TITLE <br /> t**xxxR*xxx****x*xx*t**#xxR**x******xtRRfix*x*xxtRt#*F*xx**x*R*R**k#t**xtk*xxx*******x*xxxxx <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 /> SCHNITZER STEEL PRODUCTS CO, <br /> Address: 12000 FOLSOM BLVD. _Zip: <br /> RAN Phone#: <br /> Date Tank Received: <br /> AUTHORIZED SIGN# AND ITLE <br /> *R*!t*RtRRRtx***tt*txxtt*******t!!R**xt#*xxRxx*t#ttt*txx**xx*R*t*t**!xx*txt*txttxR*tttttttt <br /> LN 23 049 12/88 <br /> WAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATM: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />