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PUBI.J# 1:-J.F.IIL'V.[-1 SEJ1JCl;S ,Q�Q <br /> SAN JOAQUIN COUN I Y Y. { <br /> N; .< <br /> )(X)l KHANNA ALO.,AfT.11. I <br /> jq# <br /> r.o, nox 2(x)9 ( 1601 Gall linclhm Amour) • Slocklun, Callhxnla 95201 <br /> 417dd1'1 <br /> juv N (209) 468 .141ro <br /> 11NUk1(C111)11N1) 'IAN K IIISPOSI'IION 'FRACKINC 1(1sC01(1) <br /> �N�1S �o11���,.rrr,.rrr,.r,,,r..rrr,,,,,.r....,,..r,••„r.. r, ..:,...rrr...r.r.r.,r,...r...,. <br /> Sfi(:I ION I - Public I leallh Scrvlces 'frmklug Shecl w11I accompany cacil lank affixed with Its site Identification number. 'life <br /> 'II'll klnp, Sheet Is In be telunled to Public I Icaldl SCIVICCS %110111130 1-Iily9 ill acceptance of[lie tank by (lie disposal or tecycling <br /> facility. 'I he pe(anll hofdcr Is respnnsIble. fur cn.au(ing that Ihls funu Is completed and rctunled. <br /> FACIIAIT NAW:: PHILLIPS AUTO _— _ EPA Site #CAT 00061395005706 <br /> FA(:IHI Y AUI)RFSS: XXXXX 1003 Moffat Blvd. , Manteca , CA <br /> TANK 11) #19 - _1907-01 ,4 1 - 550 gallon waste oil tank & piping <br /> ---- �__._.. tank Ihscrlpllun: -- 9 P P 9 <br /> r.rr ...rrrr.r•.r..•r.r.•.rr..rrrr r.r.r.r....r.r..rrr.r..r.rr......r•rr ..r,,.•. r ......r.rr.r......r...... rr <br /> SI.r.:I1Oit 2 - -f) be filled ouf by tank removal contractor. <br /> Innk Removal Conlfaclor: — JIM IIIORIT OIL ,_INC. DBA RICH-MAR( CONS1fZ. <br /> Address: 351 N. Beckman Rd. , 11. C. Box 357 (.fly: Lodi , CA Zip: 95211 -0357 - - <br /> Phone #: ( 209 ) 368-6175 Dale Tank Removed: 5/22/95 <br /> .rr .rrrrrrrrrrrrrr rr r.r•rrrrrr•.rrrrr.n rr rrrr r..rr..rr•r...r.rr rrrrrrrrr r.r..r.•r..rr.rrrr.rr.r.r.r. r...rr <br /> SF('I IWJ .1 . to be filled out liy contractor ^deconlamhlaling lank": <br /> 'tank Deco nlanllna(foil Contractor: JIM 11IO_R_H OR2_IFIC_DBA RICH-MART CONSIiz./Nor-Cal Oil <br /> 'Ilauler of insane <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 (_:fly, Lod i , CA Zip: 95241 -0357 <br /> Phone #: ( 209 ) 368-6175 _--__- <br /> Aulhorizcd reloesentalive of cunlrmfor crrillicd by signing Ircluly (hal lite tank has been decontaminated fn an approved <br /> manner as required by file Slate UepartmcnIt of Ilealth Services. <br /> Slgnalurc: �� ��, !_.a _t�" -- ----------------- 1711c: Vice-President <br /> r .. r.Jlr .r..r.r rr .u ....rrr• .r.rr•.r�i�..r..lr.rrr....r..r r 1•.•.r. (.. . ••.rr.....r.• ....rr.. <br /> tank Is Tree o ' a�� stli( g(IS 111( hydrocarbon vapors upon (rGtivery to Src�uiitzer Step] <br /> SHCI ION 4 - To he signed and dated by an auihorlxed I'epl'eser luilve a Illc ltcalrncnl; storage, or disposal facility* <br /> accepting lank and/or piping. <br /> Facillly Plaine: Schnitzer Steel Products <br /> Address: _ 12000 Folsom Blvd. --.--- City: - Rancho CordovYlp; 95 2 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Recelved- <br /> slglialti : Title: /al/`k <br /> .r,..r...........r r....rr. r:..rr....;.•...r............................................................... <br /> Page 10 <br /> ER 23 049 (Rev 2/8/91) wp <br /> A bldMnn of Srn)nrgnnn Cmmq Iloah Ur<scnicU <br /> c <br />