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J 00% /•'- <br /> / ',,1 <br /> - SA►N .?O�A+�.L N LOC,?�:L HFs:]�*T•TY-i �+I 8TRI CT <br /> UNDERGROUND TANG DISPOSITION TRACKING RECORD <br /> 771 <br /> - 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 /> caquln Local health District within 30 days of acceptance of the tank by disposal or <br /> raryclIng facility. The hojdgr j2f tbS permit vith okdftr noted below jg rjW2=12le for <br /> JrA1CII.ITY NAML: PureQro Comaanv _ <br /> T.1TY ADDPJM: 1904 W. Charter Way. Stockton, CA <br /> EPA Site #CAD 009109844 <br /> TWNK ID 139- -gel - I 1 ,000 ballon unleaded gas tank <br /> s��el�tl�!!!lftfrftssl,r:lsee:!*!!*�e*!!*!s!*�e*x*asxlsx*�e*llss�tcesslr�slR�►�*l�tls�t!!!s*!!llit�es!lsslss <br /> MMICH - 2 - To be filled out by tank removal contractor: <br /> Tic Removal Contractor: JIM THORPE OIL, INC. <br /> , ct 3:51 N. Beckman Road, Lodi , CA 95240 Ztp, <br /> Phone#: j2 368-6 15 <br /> Telephone: t ) Date Tank Removed: <br /> :�t��t�rllas�e:tlt:!!�t*�rssl,tsxs�t�t*x*,��e�rs�►**s�tls�ts*�isal�!!*�t!!*�e!!*lslssssslsss*!!!s!!!!!!!lssl:tl� <br /> 8l 'It)it 377b be filled out by contractor "decontaminating tank": <br /> ., i** fkwontastination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> 351 N. Beckman Road, Lodi , CA 95240 <br /> Phonel: 209 368-6175 <br /> >...Afuthorized representative of contractor certifies by signing below that the tank has been <br /> .''t1+(.1M*a tinted in an approved manner as may be regulated by Department of Health Services. <br /> 0r, Vice-President <br /> Sl; NAIUkE W TITLE <br /> '.Rss!!ft!!lfeftlfret*,tftftftlftft!lftftitftli ittftftftftlfrlftlfrfeaxie�eft�tittltlr*irsxlftf►*llx�rlts**ikfeRfrfesax*axft*�rtx***s�txs <br /> 7(101 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> iii arw_a, or disposal facility accepting tank. <br /> EL PRODUCTS CO <br /> facility Name �rua1TZER BLVD. <br /> 1ORDOVA, �— <br /> RANCHO g1f-^"^s.�'•0 <br /> Zip: <br /> Phones: <br /> °;-.tate Tank Received• cA <br /> IZED SIGWAIW AND TITLE <br /> _fkiitlt!lltsxs!!!!ft!!!rt*!!lhtit!!<!!*�t!!*litft!!1t*�t!!!f!!! steftlis!!!!ft!!llRftltsls!!t!!lfkls!*!!!!!lefts <br /> 2� 049 12188 <br /> UNG INSZRM'i'IONS: Fa.D IN HALF AND STAPLE. AFFIX PROPER POSTAGM. <br /> SAN JOAQUIN ifX.A[, HEALTH DIS4RICT <br /> ATTN: UNDERGROUND TANK PROGRAM . <br /> ` P. 0. BOX 2009 <br /> �' STOam"o Ch 95202 <br />