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• S3licIY JOA.Q�iV LOCA.L. H.fi'.AI,'I'H *T SZ�iI C'rr <br /> uNammotmD TANK DISposmoN TRACKING R®oURD <br /> RtRRRi}}fARttlt#!tfltRtlRlflttfR!lRRfRRR#t#RRRttfWRRRRfRRWRRRf*!Af!*tt**tllflfR*f!R**fRA}RR <br /> AL'1'If�i 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> 49fixed with its site identification number. The Tracking Sheet Is to be returned to San <br /> aonpuln Local Health District within 30 days of acceptance of the tank by disposal or <br /> XR:Cyeling facility. The holder of ogjQX Is responsible for <br /> ammmripp that this fam is eCaoletg and returned. <br /> ?#=UTY NAW:_ Sav-Trac <br /> 0%=TY ADDRESS: 4546 N. Wilson Way,, Stockton, CA <br /> TW Ip 139- - U 1 - 8,000 gal . gasoline (regular) tank <br /> RRAlAftAlAtRR*R!!1fltRflRRARR#!W*lxRtt*t#ttRARRR*RRt*Wt*RR*RRRRRtlAA*lWRRRA RRIlR!*tRR*1f1tR <br /> SMON - 2 - To be filled out by tank removal contractor : <br /> %M1k Removal Co6tractor: JIM THORPE OIL, INC. <br /> 351 N. Beckman Road, Lodi , CA 95240 Z1 <br /> Phoonnsl: p(2011 7 <br /> Telephone: ( ) _Date Tank Removed: <br /> �tRRRRRRARttf1RR#tRRlfRttfttRtlRR*ttllRttRARWlR*!Rlff#**!tltfRRtt*tARRA*RRAAiAR}RtlAtRAR}!tR <br /> ION 9 -Tb be filled out by contractor "decontaminating tank": <br /> Decontamination" contractor: JIM 1HORPE. 011_, INC. / Nor-Cal Oil , Hauler of rinsate <br /> = 351 N. Beckman Road , Lodi , CA Z1 95240 <br /> Phone/ (209 369-6 <br /> AUtlacixed representative of contractor certifies by signing nelow that the tank has been <br /> #$0W*4 urinated in an approved manner as may be regulated by Department of Health Services. <br /> __ Vice-President <br /> STOMA AND TITLE <br /> *RRRRfffRRfR*YR#tltR**!lf1RtY*!#lRtRt RRRR#R**#tRRRWYt*RRA*AR*AtR#Rtt**tf AtARRRAR4R*#tRttlRR <br /> M.li`iON 4 - To be filled out and signed by an authorized repreenetative of the treatment, <br /> •tagop, or disposal facility accepting tank. <br /> mcility Name SCHNITZER STEEL PRCDUC <br /> RANCHO CORDOVA, CA ``��--- <br /> [eaiC 91G2 00 <br /> _. _ —Zip• � - <br /> ' <br /> a1M Tank Received• ) I 11 TV <br /> AVI410 ala SIGNA'IRW AND TITLE <br /> RRRRRtiARRRfRYRttRfRltlt!*R*ffYlltRRiff*!RR#RRRIflRlR*flRR#R1tfA*Rft*RRAfftR**RlRRRlf**ARtR <br /> !) 119 12/88 <br /> INSTRUCTIONS. F0LD IN HALF AM STAPLE. AMX PROPER POSTAON. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: LWMERGROL14D TANK PROGRAM <br /> ` P. 0. BOX 2009 <br /> RTOCK70K, CA 95202 <br /> �1 <br /> 1 "� <br />