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gp ,7OAI N LCL � t"'T1DI BTRI GI' <br /> UNDERGROUND TAW DIBPISITICH T!"aIN(I R@0" <br /> *RRRRRRRRRRRRRRARRRRRRRRRRRRRARAAlARRARARARRRAARRAAR�a�IARR��BtlyilllaOCRp�nylP-aGI1#tank <br /> B�GTICN 1 - The San Joaquin I.acal Health District's �J <br /> affixed With its alta Identification number• <br /> The Tracking Sheet is to ire returned to Ban <br /> .]oaquin Local Health District within 30 days of acceptance of the tank by diapoaaI or <br /> recycling facility. L_LhaAx"1" <br /> FACILITY NAHL: Babka Distributing <br /> FACILITY ADMESS.. 1245 W. Weber Avenue Stockton C ,� �� 7V <br /> ,�- <br /> 02, 1 - 3,000 gallon Diesel fuel tank EPA Site # <br /> TANK ID 1 <br /> *AARRRARRRRRAARRlRAAAAAAAARRAlAAlAAAARAAAARRAAAAAAARAAAAAAARAAAAAAAAAAAlRAlAAlRARARRARAlRA <br /> 0WrICN -- 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM T11QRI'E QI L INC. <br /> 351 N. Beckman Road, Lodi , CA 95240 Zips <br /> Addresst Phonelt �2 368-6175 <br /> Date Tank Removed: <br /> Telephone: ' <br /> RAAAAARARARARRAARARAARAAAAA#AARRAARAARA���COnAtalfinatlfl[JAtank�AiAAAiARAAAAAMRIiR�RRIRAAf <br /> 9HfrICN 3 -To be filled Out by contractor <br /> Contractor: JJIMT{IORPE 011_ , INC. / Nor-Cal Oil , <br /> Hauler of rinsate <br /> Tanis Decontamination" <br /> Con 351 N. Beckman Road , Lodi , CA Z[p: 95240 <br /> Address: Phonel: 209 368-6175 <br /> Authorized representative of contractor certifies by signinDepartment <br /> lowthatof Healtthe h has been <br /> decontaminated In an approved manner as may be regulated pa <br /> icb- <br /> Vice-President <br /> SIGNATURE AND TITLE <br /> AAAAIRA*AARAAlRRRR!#ARARAAAAAARARARAAAAAAAAanlauthorized Rt:epresnetakiveloflthe ltreataent, <br /> out and signed by <br /> storage, or dispose A! <br /> 8PICTION 4 - To be fxlfQcllity accepting tank. <br /> Facillty Name rv1 <br /> Zips <br /> Address t phone l: <br /> Date Tank Received: <br /> ALMIOR I ZEII 9 I GNAIR VE AND TITLE <br /> ARARAARARARAARARRA*lRRARARARAAARRRAAARAAARAARAAAARAAAAAARAR#fkAAAAlAAARlAAlRRAlAlRAAARRRAARR <br /> rff 23 019 12/01 <br /> "AI I.INQ I N3'[RWrI ONS: IN HALF' AND STAPLE. AFF'I X PROPER Pn.9T <br /> SAN JOAOU I N LOCAL, HEALTH D I 9TR I CT <br /> AT`iN: UNMGROWD TANK PROGRAH <br /> p. o. 'BOX 2009 <br /> STOO ". CA 95202 <br />