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S�r J TL4 COUNTY PUBLIC EEALTH SERV <br /> a_: O.NNM,4- _kL BE.ALTE DMSION <br /> LNDERGROUND STORAGE TANK DISPOSITION TRACKENG RECORD <br /> .aaxaaxaxaaa:x:aaaxxa:aa+a:a:aaxxsaaaaaaaaaaaxa:axa:a:s:aaxa:a:aa-:xxaxa:rxxac—xa.xx ----asa:zxaxxa:a:a:asa.xxaa <br /> SECTION 1 - P:ciic Health Services Ezv:ro=eami Health Division Tar_K T Mck�Zg Sheet shall accompanv each tank af:-.ed With <br /> its Site ;dczt::.Caron a=ber. ice Tars T acY:II3 Sheet is to be to P bilc Heals`.:Services E_.virorme:nal Health Divisior. <br /> within 30 days of acceptance of the taax by tie disposal or re:vclitlQ iacdirl. T e permit holder is respers:oie for ensuing, tat <br /> this Fo= is comcietet and re=e,-4. <br /> FACE_T-`.'' N.—NI=-: Central California Traction Company <br /> CSC 002106440 <br /> , <br /> .� , �.„ .�DDR=SS: 1645 Cherokee Rd. , Stockton , CA 95205 <br /> FC:_ 1 . <br /> . ID j39 - / �j� -C> Z�.-"-`�-K SIZE: `�� (_^ PRE"SOI S "�tiK CONTEv'IS:�! i <br /> xaaxa xaaxaxxa>axxa:xaaaxasaxa..... .y:axaaaxaaaaa:aaaa:aszaxaa:xaaaa.a.a:aaaxasaaxxxaaa+aa:x:aaa----:aaaxxaaax <br /> SECTION '_ - To be Tilled out jv tank removal cont:-ac_or: <br /> Cn� Jim Thorpe Oil , Inc . <br /> T ark Re mcva C actor: <br /> Lodi C:? 95241-0357 <br /> ,ceresS: p .0. BOY 307 C; <br /> 209 368-6175 Date Tans Remcve : C <br /> xasa.axaaaaaxaaaxaaaaa==..a,.xaxx.ax=aa_x,..xxx,.x=x=xa,.a=xaxxax..xaxxxxaxaa <br /> SECTION nilet cu:by coarrac.or "decontaminating tams": <br /> or -or,Cor_trac:er: = Th C r-De -- <br /> =oci , C= 952 57 <br /> �.^reSS D. O. Box 7 C:tv: L'� _1-03 <br /> P`cre t i <br /> 209 ) 36S-6175 <br /> :t^.orzed :eorese t::t;ve of cont-ac:or :_. .�,ir<� �'ou=^. si�:ature be:ow that �.e ::ak sas bee^::e,^CntiIIulnaCZ^ '-^ an aLorC�e <br /> "a,.ar ler as : c_uir e.. Dv Cal EP.-I. <br /> Date <br /> va, a: ��t i �-OQ- F Tice: Co^ _raCtOr SiT:ature - <br /> � _�2-- l•� <br /> a iaz.................................................. <br /> zzxi] . .aaaazazzziaiiaiof[.........zzzxaaazxaazzasa=fuss Zzzixxaxzzafaaxzazzzxr <br /> I,an afree ;of sal l slud(7es and h,Ydrocarbon vaUors upon del iveg 10 S8hki tzer.-.�teel . <br /> 11� ', o ,.e s =ec and uat_c 5v an anZ:14r:Ze� r-presen rive OI .::e �t .+e.:. szc .aa_, or � Sctl ..:ti..11 <br /> ac==vi 1g tans and/or pt-pin- <br /> Fac--"- <br /> t-pi^.- <br /> Facairr N=e: SC:-n Stee- P o du c` <br /> .a tS `1 0 1D -c I s c r", E ti M C:rv: -_-r c h C C C r d o'Z± C' C^;✓ t o n <br /> Cdr.. S: �- <br /> F,tCne n: i a-_,o" 9S5'-4S" 0 <br /> Date Tars Re__.S:e:!: 2 (2 ) y LQ <br /> ^.e �tC, �, c�/0c� Tide W h►'t6 Tt•r $iw-. Date 2- ��i t <br /> xx z aazx zzz <br /> ...................zz........................x........................................ <br /> alcaaxx a<aaxazaaaa�......a.zzaa.. .ayxaaazzazxiaaz.[.[ <br /> Re,:<ec iC1iG-cg Pa2t 10 <br />