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REMOVAL_1989
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0502438
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REMOVAL_1989
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Entry Properties
Last modified
1/31/2019 3:41:45 PM
Creation date
11/8/2018 9:36:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
1989
RECORD_ID
PR0502438
PE
2381
FACILITY_ID
FA0005447
FACILITY_NAME
LODI READY MIX & BLDG MATERIAL
STREET_NUMBER
851
Direction
E
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
851 E LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Supplemental fields
FilePath
\MIGRATIONS3\L\LODI\851\PR0502438\REMOVAL 1989.PDF
QuestysFileName
REMOVAL 1989
QuestysRecordDate
11/24/2015 7:10:25 PM
QuestysRecordID
2933078
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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SAN .7 OA JI tJ ICC. . <br />Cl_.i�:►:.e- T=;7�=T:i�it�! i�S��•'�3�i� �f"a��:iT:ii::c7�T���_; � <br />xxxttxxtttxxxfrfetxxtttxxtttftxxxxxxtxxxxxxxxxxttxxxtxxxtxxxxxxxtttxttxxxttxftttfttttfet:xttttttir <br />SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with its site Identification 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. Mx holder of the permit wig number noted below is responsible for <br />ensuring that this form is cgWleted and return_ <br />FACILITY NAME: Lodi Readv Mix <br />FACILITY ADDRESS: X51 E. Lodi Avenue, Lodi, CA 95240 EPA Site # CAC 000158517 <br />TANK rD 139- I3 S -Q, <br />x�txxltxxxxxxxxxxxxxxftxx�Rxitxxxxxxxxxxxxx*xx*xx+rxitxxrt*xitsxs�t xxxxx�tx*x*xftxxxxxftxxxxxx*tuft*xxxR <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: JIM THORPE OIL, INC. <br />Address: <br />x <br />oad, Lodi, CA <br />_Zip: 95240 <br />N: (209) 462-458 <br />Telephone: ( ) Date Tank Removed : <br />tatttxfttttttxxxftxf: xxtxxtttttxxxftxxxxttxxxxtxtttxttttxxxxttxtttttttfttftftfettttttttttxttttttttt <br />SWTION 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: 807 E. Black Diamond Lodi, CA Zip: 95240 <br />Phone#: (27 462-4581 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in an approved wanner as may be regulated by Department of Health Services. <br />'-Z'816NATLIRF AND TITLE <br />xttxxfrxxfrxxxftxxxftx*xx*****x******xtxtxtxfrfrxxxxxxftxxxxxxxxxxxxxftxxxxxxxxxfrxxxxxxxxxxxxxxxxxx <br />SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br />storage, or disposal facility accepting tank. <br />Facility Name ;;;:;r:-- ^- - <br />RANCHO CC: <br />Address: <br />Zip: <br />-_ -_ -- Phone # : <br />Date Tank Received: <br />AmiokfzED SI ATC <br />*tttxxxttxxxfrxxftffftxxxxftxttttxxxtfttxftxxfefrxxxxxxxf� <br />RH 23 049 12/88 <br />MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. <br />AND TITLE <br />tttttttftxftxxtttxxxxxtttttttxxttxxtxxxtxtt <br />AFFIX PROPER POSTAGE. <br />SAN JOAQUIN FOCAL HEALTH DISTRICT <br />ATTN: UNDERGROUND TAW PROGRAM <br />P. O. BOX 2009 <br />STOCKTON, CA 95202 <br />
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