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S,ev LZv COUTY PLBLIC HEALTH SEF S <br /> E2N-;1RONNMNTA L HEALTH DIVISION <br /> UNDERGROUND STORAGE TAYK DISPOSI'T'ION TRACIUNG RECORD <br /> =.x......i.................................................................................a................ <br /> SECTION I - 111,ibiic Health Se^„ices Environmental Health Division Tank Tracking Sheer shall accompanv each tank aff:ed wit:. <br /> its site ident;5cation number. Tne Tank Tracking Sheet is to be returned to Public Health Services E.nvironmenr al Health Division <br /> within 30 days of acceptance of the tank by the disposai or recvclino facility. The permit holder s -esponsioie for ensura hat <br /> this form is completed and rer=ed. <br /> F ACILIT`Y NAAti1E: <br /> Central California Traction Company EPA _ CAC 002106440 <br /> FACILITY ADDR=SS: 1645 Cherokee Rd. , Stockton , CA 95205 11 <br /> T?,v`K ID 39 TA:v`K SIZE: 1�Ct�0 �- PREVIOUS TANK CONTENTS:����etf <br /> l:z � <br /> ...............x........11..............._........#1[............ [I6.................*...fit............Jas.....x= <br /> SECTION '_ - To be filled out by tank removal contractor: <br /> Tank Removal Con, actor: Jim Thorpe Oil , Inc. <br /> Lodi , CA Z;_, 95241-0357 <br /> Address: P.O. Box 357 Cirv: <br /> Phone n: ( 209 ” 368-6175 Date Tank Removed: <br /> =xx=xx.. .xx......__,._____,.__,.___<.___=........................ ........ .....................<_,......==xxxx <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontan:.inatior. Contractor:—J i. Th c r p e Oil , n c . <br /> Address: P.0. Box 3,57 Cirv: Lodi , CA Zit : 952!1-0357 <br /> Phone R: i 209 ) 368-6175 <br /> Authorized representative o;conUac.or cenifvin_ through sig.^.atnre bellow that the tank as been decontaminated in an approved <br /> manner as rewired by Ca' EPA. <br /> Name: Title: Contractor Siznature: �L� ate of <br /> ..........................................=.a.............................*...... xx <br /> S�� �� =fr=e of. all� sludges and h dro rbon va Ars upon deliver to Schnitfer.,Steel . <br /> ' IldC 4 - �i o be stpea and dar by an auti�ortze�represen ttve of t�Ae ..eat:.eat. stage, or mspesal :aCillCr <br /> accepring tank and/or piping. <br /> FacidirvN=-e: Scrritzer Steel Products <br /> Address:12000 Eolsorr Bled. Cirv: Rancho Cor dolt; C 95742 <br /> Phone : ( 916', 9,S5-4 <br /> S10 <br /> Date Tar k Received: <br /> Nanne:�U t O F- C -f 6A Title: U Dat /0 <br /> ___...........===x=====_____.__==...xx.....x..=....._......___......_.._...................x=............ <br /> FH _3 Cab (Rev-.sed 10/19/98) Page 10 <br />