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•'" SAN acu*4 N LC AL H a,r-Z+� Die TE2I C W <br /> ..._. .._.r, _..... _J..._.. .......��.... <br /> UYDL4iGt�Ol01D TMMC DISPOSITION TRAC KINC3 RF7C70RD <br /> rwersdr 1 - The San Joapin Local Health District's Tracking Sheet will aacompmy each tanic <br /> atfhad with its site identification number. The Tracking Sheet is to be returned to San <br /> JON4nin Local Health District within 30 days of acceptance of the tank by disposal or <br /> rec.mling facility. The holder of the Dersit with n ftr noted below, is XC U . <br /> ithat this far, 011g,i returned '� <br /> mna <br /> .12kcMITY NAM: LarQin's Service <br /> VA=TY ADDRESS: 2235 Cherokee Road Stockton Ca <br /> � G,o 00 <br /> gas tank EPA Site # CAC 000223089 . <br /> ON - 2 '.7 be filled out by tank removal contractor: <br /> ,ft* Removal Contractor: JIM THORPE OIL, INC. <br /> !tlss: 351 N. Beckman Road, Lodi , CA 95240 Zi <br /> Phone#:Zip: <br /> 368-6177 <br /> Date Tank Reaoved:- <br /> Alwlrg <br /> 3 Ta be filled out by contractor "decontaminating tank": <br /> '!`nk Deccntomination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> 351 N. Beckman Road, Lcxii , CA Zip: 95240 <br /> Phone#: (209 368-6175 <br /> : horlasd reprTntative of ontractor tifies by signing below that the tank has been <br /> W*Wlneted am y be regulated by Department of Health Services. <br /> _ , <br /> Vice-President <br /> rngtank. <br /> AND TITLE <br /> , "Brit*ttftl�t!! !!# #0 Tb filled out sauthorized;represnetative of the treatment, <br /> siEaugs, or cis' 1 facility ecce <br /> ;.ability Name <br /> • ZbfS6 yj ib'A 88918 . <br /> oaaoa o Zip: <br /> d phone#: <br /> Tank Rede ived: <br /> Ai1THOBIZD SIGNA AND TITLE <br /> 049 12188 <br /> 1/ ..IN JCTI�I3: FSA IN HALF ANDSTSPL AFFIX PROPER POSTAGE. <br /> SAN joiaiIN LOCAL HEALTH DISTRICT <br /> ATM: UMDERQ X)ND TANK PROM M R•.. <br /> P. 0. BOX 2009 <br /> STOCKTON CA 95202 - <br /> T <br />