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SAN JOAC&N LOCM, H� Ar•TH �+ISTRZC'I' <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> iiii*fff!!!t!*tltRlft!!t*!*!tR***!*!*R**tRRRRlt**t*ttY*RtxRR*lRRRRtfi*ttlR*!**RfttRt*t*!!t*t <br /> 8WrION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> Affixed with its site _dentification 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. holder of the oernit-Arh number noted below Is �r sponsible for <br /> Lina that this fora is completed and returned. <br /> FACILITY NAME: Sav-Trac <br /> FACILITY ADDRESS: 4546 N. Wilson Way, Stockton, CA <br /> TANK ID 139- 17 73 __ O 1 - 8,000 gal . Diesel tank <br /> ilttRlRt*lRIRRfilt!!**tt*tRlR**tltt*!tR*RR**!Y**Y**!R*R*R!R*Rfifit**!*!!!!t**RR*!!!*!**t**t*Rf <br /> BA CPION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Cordtfactor: JIM THORPE OIL, INC. <br /> Address: 351 N. Beckman Road, Lodi , CA 95240 <br /> Zip: <br /> /Phone#: (z 368- 17.> <br /> Telephone: ( ) 111 <br /> Date Tank Removed: ZE yZ ��y <br /> 3tif*tttfRtR***R*Rtlt*R!***R*t*tY***f*R**x**Y**!****R**RR*tt!***klRRltlt* titxtt!!*!*t!!!f! <br /> RKTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> Address: 351 N. Beckman Road , Lodi , CA Zip: 95240 <br /> Phone#: (2097 368-6175 <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 /> Uice-President <br /> SIGNATUFff AND TITLE <br /> f!tltRltltlRt!***tilt*Rl4RRx*t*fiat*!!Rfi!*Rt*RtR!*t**xfilxRRRRR+RfiRRRx*R!*RRx*x*Y******x*!**R <br /> SBCTIOII 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name SCHNITMR STEEL PRODUCTS CO <br /> 12000 FOLSUM ULVU. – �— <br /> Address: RANCHO CORDOVA, CA 95742 <br /> 916-985-4810 Zip: <br /> _ <br /> Phone#: <br /> Date Tank Received: S/ _ <br /> AUTHORIZED SIGNATURE AND TITLE <br /> SH 23 049 12/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> S"110 MUM, Kai 95202 <br />