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SAN 2JOAQ IN COUNTY PUBLIC IIEALTII SERYIC S <br />ENVIRONMEIVI'AL HEALTII DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECOMI) <br />}}4iiiit}4##4##*i*#44#444##4444*#++t4##+##ttt4ittt#t+*#t4#i##tt4#t*tt#t#t444t#144#44#*•!4#**44#♦**��*4�1#4+t+� <br />Public Ilealih Services Environmental Health Division Tank Tracking Sheet shall accompany each lactic I fflzed <br />Willi Its lite Identification number. The Tank Tracking Sheet is to be returned to Niblic Health Services privirortmental Health <br />r)Ivisioti within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder Is responsible for <br />ensuring that this form Is completed and returned. <br />FACILITY NAME: The Port of Stockton E.P.A. # CAIS 000041 1 <br />r-ACII.ItY ADDRESS: 2201 W. Washington St., Stockton, CA 95203 <br />TANK ID b39 f --C? TANK SIZE: 12,000 gals. PREVIOUS TANK CONTENTS: Iirij AacjQrj gasnn� <br />l; <br />+♦+�++F+}++*#+##+#+##4######44#+#+######}++#######*#*}#+4t##*#t##t#t#*#t4tt#*###44#4##4444###4444**'M':##44#4 <br />SF. C,l,lON 2 • 1'o be filled out by tank removal contractor: <br />lank Removal Con(ractor,. Jim Tharpe 011 luc. <br />Address: 351 H. Beckman lid./P.O. Box 357 City: Lodi r CA Zip: 95241-035' <br />Phone 368-6175 Date Tank Removed: <br />SECTION 3 - To be rifled out by contractor "decontaminating tank": <br />rink 1)econtatnination Contractor: Jim TThorpe Oil, irnc. <br />Address: 351 N. Beckwan Rd./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />111torte A: ( 209 } 368--6175 <br />Amboilf.ed tepresetttative of contractor certifying through signature below that the tank has been decontaminated is in approved <br />manner as required by Cal EPA. <br />I`larne: Title: Signature: hate <br />## ##+►### i##i*###414##*414## # #tot## 44 * * 44t444 *t*# #+t+##4** <br />1 ar� K i s Tree a s 1 UNI anti yc�oearhon va Fors is on d'e ver d n t i r teel. <br />SEC JON 4 is be signed and dated y an attt o to represents Ive of t c treatment, stn age, ar spos acii ry <br />accepting lank and/or piping. <br />Facility Name: Schtiitzer Steel ProducLs <br />Rancho Cordova, CA <br />Atltlress: 12400 l*©l�otn Blvd. City: Zip: 95742 <br />Phone #: ( 916 ) 985-4810 <br />[)rite Tank Received: <br />Llante: Title: Signature: Date_ ^ __ <br />cif 21040 (Revised 9/11196) Page 10 <br />