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~ PUBLIC HEALTH SM VICES <br /> SAN JOAQUIN COUNIY � <br /> JOGI KHANNA NI D.,RVII. <br /> Ilcallh Offirrr •.,�i `� <br /> P.O. Box 2009 a (1601 East Iluchon Avcnoe) a Stockton, Callforrda 95201 �( <br /> (209) 4683400 <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> •••••.••r••u••j•r•r•••••••••rr••rr••r•r•••r•••••rrrr••••••r•rrrr••rr•••••rr•••r•r••••••••♦••r•••••••H••r• <br /> SECTION 1 - Public Ifeallh Services Tracking Sheet will accompany each lank affixed with Its site Identification number. 'Ilse <br /> Tracking Sheet Is to be returned to Public I leallh Services Lv It tJlt 0 duvg of acceptance of the tank by the disposal Of tecycliog <br /> facllily. Tine pennll holder Is responsible for ensuring that this form Is completed and returned. <br /> FACILITY NAME: J MAR - STOCKTON PETROLEUM EPA Site #CAC 001010216 <br /> FACILITY ADDRESS: 4075 E. Main Street, Stockton , CA <br /> TANK ID #10 - 39-1667-04 Tank Description: 1 - 350 gallon waste oil tank & piping <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> 'Tank Removal Contractor: JIM THORPE OIL, INC. , DBA RICH-MART CONSTR. <br /> Address: 351 N. Beckman Road, P. 0. Box 357 _ City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 368-6175 Date Tank Removed: June 6, 1995 <br /> SECTION 3 - to be filled out b'y contractor 'decontaminating tank': <br /> Tank Decontamination Contractor: Stockton Service Station Equipment Co Inc <br /> Address: 808-820 N. Union St. City: Stockton, CA ZIP: 95205 <br /> Phone #: ( 209 ) 464-8333 <br /> Authorized representative of contractor certified by signing below that the lank has been decontaminated In an approved <br /> manner as required by the State Deparinnent of flealtin Services. <br /> Signature: see attached Certification of triple rinse Title: <br /> .. ••!••.•...•.•••. .•••r••r••r•rr•r••r••rrrr•r•r••••••....•...••.•.•.•......,.•••....•rr rr•r•r•••••r•r•r <br /> `rangy i frQQe of a�l sl�,c��e3 and hty,qrofaybon vapors �lP�n �1livehrycrJl� �� <br /> SECTION 4 - To be signed an t to by an a d for ze represet a Ive to r acme <br /> accepting tank and/or piping. <br /> Facility Name: SChnit7ar Step] Prpolirtc <br /> Address: 12000 Folsom Blvd. City: Rancho Cordova Zip: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: J ne 14, 1995 <br /> Signature: Title: <br /> Page 10 <br /> EH 23 049 (Nov 2/x/91) up <br /> A Dld,lon of san Joaquin C.ounry llahh Cue krvlcu �) <br />