Laserfiche WebLink
SAN JOAQUIN COUNIY =' <br /> r. <br /> YOGI KHANNA Alb.,M.P.H. <br /> IIcaIlhOflica ���:• <br /> CO. nox 21x09 • (1601 East Iiaxchon Avcnoc) • Slocktun, Cxaloroix 95201 rtfxi)d <br /> (209) 4(&3400 <br /> UNDKItVROUNO TANK DISPOSI'T'ION TRACKING ItLCOIID <br /> ••rr•rr•r••r•••rr•••..•••••••••••rr••••.•••••r••.•••n••r••r•r•••••••r••ur•••••••••••••••••••••••••••••••• <br /> SECI ION I - Public I Icallh Scrviccs Tracking Sheet will accompany each lank affixed with Its site Identification number. The <br /> frocking Sheer Is in be returned to Public 1 leakh Services within 30 dnrs of acceptance of the lank by Ilse disposal of recycling <br /> Inclilly. 'I lie permit holder Is responsible lot ensuring Ilial Ibis form Is completed and returned. <br /> FACILITY NAME: Golfland Arcade EPA # CAC 000722176 <br /> FACILITY ADDRESS: 7850 N. West Lane, Stockton, CA 95210 <br /> 'TANK IU 0'39 •oZ 3 1243—o I 'Tank Dcscrrptiun: 1 ,000 Gallon (gasoline) (diesel) (W^moi) <br /> ••••..r••r•••i•r•rr.••...r•..••.•..r•..••...•..•.•....•.•..•..•••••.•..••.•••..•.••• ••. •••. •••.•.•. <br /> SI'sCl ION 2 - 'fo be filled out by rank removal contractor: <br /> 'Imrk Itenloval Contractor: JIM THORPE OIL, INC. OSA RICII-MART CONSTR. <br /> Address: 351 N. Beckman Rd. , 11. 0. Sox 357 City: Lod I , CA Zip: 95241-0357 <br /> Phone d': ( 209 ) 368-6175 Date Tank Iternoved: /O I I q <br /> r r+•r•u••r•rr•rrr•••••••r•rr••••r•••.•••r••rr•••••r••••••r•••••r••••••••••r••••••••••••••••••••••••r•••••r <br /> I <br /> SFGI ION .1 - to be filled out by conUnclor "decontaminating lank": <br /> 'Bink Decontamination Contnctor: _JIM THORPE OIL, INC. BBA RICII-MART CONSTR./Nor-Cal Oil <br /> au er of r nsate <br /> Address: 351 N. Beckman Rd. , 1'. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone d': ( 209 1 368-6175 <br /> Aulbollied reineseninlrve of conwidot cerllRed by signing below Ilial the rank has been decontaminated In an approved <br /> manner as required by the State Department of I lealih Services <br /> Signature: � �_ y _ Title: V , t-0 • <br /> •• •••r•• r. ••. • ••••.••• r••••..•• ••••••.•ri•••••r••• • Ivery• ••• r ••••••••••••• •••••••• <br /> '(:I ION free of alt and da( 'a';i*(( va�lors u�on (,Carl ery to S'cluii�zer StjFj <br /> SEC 130N 4 • 'I'o he signed and dalcd by an nuOrorlced represer Indve o the teat"car, storage, or d sposal fac 1 y' <br /> occcpling lank and/or piping. <br /> rscIUIy tante: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordo WIp: 95742 <br /> rhone A': ( 916 1 985-4810 / <br /> Dalc 'laak Received- <br /> 'ed, <br /> Signature: Thle: <br /> rage Io <br /> Ia 23 049 (Rev 2/9/91) up <br /> A oidium d S+n)mTAn Cmmry Iluhh Urc Scnki, \� <br />