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p�y bra I N L(X'-A� t4RLAI,Z" I S'I'RI Crr <br /> UNDn"to M TAM( DI EPOS I TI ON TRACKING RMOMD <br /> #llRAtAtRRtt!ltRtt#R#R##A#!#*###R!#*!#*##*##AJAR#####*##*#RRA*#*RRAR#ARR#lRARltnRReachtank <br /> S'OiGTION 1 �- The San Joaquin Local IiealthDistrict's� <br /> � Tracking acking Sheettisill to be returned to San <br /> affixed with its site identification number. <br /> Joaquin Local health District within 30 days of acceptance of the tank by disposal or <br /> recycling faci 1 ity. The h der <br /> Is re*QQD&UZjC_j"_ <br /> FACILITY NAME: Babka Distributing <br /> FACILITY ApI)RI 9: 3245 W. Weber Avenue, Stockton CA <br /> FACiL <br /> EPA S� e <br /> TANK ID 839- $�° o 1 - 10,000 gallon unleaded gas tan <br /> C <br /> #*R*R**#####*R*RR##***#t**#R***!#R#**#1t**A****#***R##**#A*#A*AA***#A!*#R#*AA#R##!#RAR#R#A!R <br /> 80CC'ION - 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: 300_6175 <br /> Phonell <br /> Telephoner I ) Date Tank Removed: <br /> **#A**tA*R*##R***##**R#R##*#***A****#*#***********RA**ARA*R***##A#*#A#**tA#BARK#Rt#RR!#RAR# <br /> SWrION 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: (209 368-6175 <br /> Authorized representative of contractor certifies by signing belov 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 /> SDCPION 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 /> Zip: _ <br /> Address: Phonel: <br /> Date Tank Received: <br /> AUTHOR I ZED S I GNATlj2E AND TITLE <br /> tH 23 049 11/08 <br /> MAI LILAC} I NSTRUCTI ONS: F'O(..D IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAOU I N LOCAs. Ff &TH DISTRICT <br /> Arm: UNDERGROUND TANK PROGRAM <br /> p. O. BOX 2009 <br /> STOC]{T N, CA 95202 <br />