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. �pN .7a1+,�N LOC�.l�L IE�fi'.ALZ'1-E �ISZ'E2ICZ' <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> f#RBBB#f#ftR ttRRRRRRffRRRR#fRRR#!#RRAARf R#ABBE*RRR#ARRtf#RRRARf R*AftRAf RRAf RfffRRRf Rff#fA### <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. Thei . 1` with number note below 1s resoonslble folonsur ` <br /> ins that this Eort! !a comets*ed and retuned <br /> FACILITY NAME, Babka Distributing <br /> FACILITY ADDRESS: 1245 W. Weber Avenue Stockton CA <br /> EPA Sike #C-46o0 ;7 & <br /> TANK ID 139- ya°o - o 1 - 10,000 gallon unleaded gas tan <br /> RA#*AfA*##RR*A#Rf*A!*#A#R*##*A#fR#f RA*RARARRA##RAR##RRRf##ARAAfAAM*!f*#A*R#A#f Aff RRlR#flA Rf <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> 351 N. Beckman Road, Lodi , CA 95240 Zip: <br /> Address: <br /> Phonelt �2 368-6175 <br /> Telephone: ( ) Date Tank Removed: QI� <br /> RR#R**EAR*f#RRRAAAAA*#**RR*A**RA***R**#R*AA****AARR*RARRR*#ARA#RRA#RA*f A!#Rf#R#Rf!#lAf R!*tR <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 /> 351 N. Beckman Road , Lodi , CA Zip: 95240 <br /> Address: Phonel: (209 36II-6175 <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-President <br /> SIGNATURE AND TITLE <br /> R*#AARR**RRA*##fR#fR#R*RRR#RAARR#R*ARA**RAA*RRR*R*Rf***##RARRRRRRR*#*ARE RR#*k*R#*AA*AR***** <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_ 5l'H Q \"F?-T!]?✓ <br /> Address: SCHNfTZER STEEL PRODUCTS CC Zip: <br /> AN!OCORDOVA GA 95742 Phone I: <br /> 916-985-0810 2 <br /> Date Tank Received: <br /> AUTHORIZED SIGNATURE AND TITLE <br /> RARRRRRARRRA#*AR*#R!# AR**##*RA#RfARf#R*RRR*RRA**RARE RR*#f**RA#R*AA*RRR*A*Rf*A*RRR*f*RR*#Rf <br /> LH 23 049 12/81 <br /> HAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE• AFFIX PROPER POSTAGE. <br /> SAN JOAUUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> p. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />