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lyNHEALTH ]P 13-rx;�I <br /> UNDEWROUND, TANK DI SPOB TIOU TRACKING R&M <br /> TheSane Jaagyin Local Health District's Tuck ing=Sheet,vi ll accompany.each-tank 1 <br /> •.� affixed vith its site identification nisaber. The Tracking Sheet-,is to be returned to San <br /> ' {`I Joaquin Lo®1 .Health 'Aistsict within 30 days of ,acceptance "of the tank.by disposal or <br /> recycling facilitY•ii <br /> r this.121M.-12 malatid Aw - <br /> - - <br /> k rACIWTY HAM: PANELIrAIROCKING <br /> FACILITY ADDR&'4S; <br /> 2150 E. Fremont."$treet,' Stocktpn ^ — EPA'Site # CAC 00015938]' <br /> TANK ID 039 x_I]09 11 Q2 S� i,,t O i L- TX,wk. ' <br /> j .: 82CPION - 2 " 'To be'4filled'out by tank removal contractor; <br /> 411111M Removal Contractor: Ihorge O i 1` Inc. <br /> Address: ` 351 -N, Beckman Road ' 95240 <br /> Zip: <br /> .:. Ec- Lodi CA Phonal; <br /> G Telephone: ( ' z0¢_1_' 4fi2-4581_ Date Tank Removed: 6(13[89 <br /> SWTION 3 -To-'be. filled out by contractor' "decontaminat-ing tank* <br /> k Tank Decontamination" Contractor: �J'IM THORPE OIC ,- INC./N.Or-Cal Hauler bf. Rihsate <br /> Lj <br /> Ibddresa: - 807 ' Black Diamond ;,E od i_, CA Z 1p. 95240 <br /> Phone1; (209] 462-4581 <br /> Autharized representative of contractor certifies by.signing below that the tank.- has-been <br /> decontaminated -in an approved manner may be regulated by'Departoent of `Health• Services. <br /> J Vice-President;" <br /> I �1 1GNATUM AND TITLE . <br /> H <br /> .802TION 4 To be filled out and signed by an.authorized .represnetative of the treatw-nt, <br /> storage, or disposal facility accepting tank, , <br /> 4. a hac i l ity Name , <br /> Add[ess: -„ 8CHNn7ER STEEL PRODUCTS-Cu. zip: <br /> - - -- -- Phone 1: <br /> Date Tank Rectiived= J <br /> ;F AUIMORIZM SIGNATW`AND TITLE <br /> *�*###a#x#*�**#*#*#*#*�##�t#*�**t*****#�x��t*#�t*eeexa#**e**#*#sr#_#,reit##**�*t****t****�xxt###** • . <br /> HAILING INSTRUCTIONS: FOLD IN HALF AND�STAPLE: AFFIX-PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL H$M.TH DISTRICT <br /> ATI'N;-- iNDFRGRCM TANK PROGRAM <br /> P. Q.' ' BOX .2009 ' <br /> 8T=7Mr .Ch" 95202 <br />