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SaAN JOACOIN LOC_Aa, IIFJALTH�ISZ'E2IC'1' <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> AAlf!#f##*!A*k**RAAAAR**A!**A****A***BARB*A!A!!AAlAAAA**AA*!#!**ARA******#A#**R*A*****f*A R! <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 the Peryalt with ngmlor noted be m2RAR Wk 191 - <br /> ensuring that this form is completed and returned. D o <br /> FACILITY NAME: Alves and Perry <br /> FACILITY ADDRESS: 18700 Tom Paine Road , Tracy, CA SEP 2 1 1989 <br /> EPA Site Exempt UndergNolR NP �TII2W�E3aTnx <br /> TANK ID 139- - FF TA <br /> A*AR*A****#*kR*****A*RARAAlAR****R***AA**AA*AA***RR**RBBB#*R***!!**AA!*ARA**A!R**R!*#*AlAA! <br /> SECTION - 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 /> Phone#: (2 368-6175 <br /> Telephone: ( ) Date Tank Removed: 8/2/89 <br /> lAAAlAlAAAAA*!A***RAA**lAAA*R*ARAB*ARRRRAA********!*A*****BABA***A!A!*!*RAA*#*#!*##!A!lAARA <br /> SWTION 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 /> _ <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-Presiden'. <br /> SIGNATURE AND TITLE <br /> ***ARRA*A!!*kRA****RARR*RAk*A*A**A**RkA*RR*�AR�ARAk**Ak RRA***RR@RBBB*RAARR*RR**Ak*k*kRAR*RA <br /> SECTION 1 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name FCHNf190 FOC-LSOPRODUCTS CO. <br /> RANCHO CORD a, 7� <br /> Address: 31 _ <br /> — Zip' ------ <br /> G <br /> —Phone#: _ <br /> Date Tank Received:_ ��0 <br /> AUTHORIZED SIG NA1 RE AND TI'T'LE <br /> *R!!A!A*RAR*AKAR*R*!A*RARAAA*R*A*A**RBBB**A**RAARlfAA#A*AAAA****RAA !A****A******R*AAAA!#!! <br /> SH 23 019 11/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL. HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CIL 95202 <br />