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'k PUBLIl HEALTH SEM�ITCES., <br /> SAN JOAQUIN COUNTY <br /> JOGI WANNA KD., 4111. '� J <br /> P.V. Box 2()09 • (toI East flazelton Avrnue) •stockton, Califol 95201 <br /> (209)468.3460 <br /> UNDERGROUND TANK UISrOSITION TRACKING RECORD <br /> `k araaaa-••rf•faaafa•aroaao•1ato*too rarlftoo afrrato****to o1lfar!!frlaa7r44oaaRo/al044044rfoollraofo!H 4r!!!ro! F <br /> r SECTION I - Public I Iealth Services Tracking Sheet will accompany each lank affixed with its site Identification number. The I 1 <br /> s Tracking Sheel is in he retutned to Public I lealth Services within 30 dots of acceptance of the tank by the disposal or recycling <br /> facility. 711e permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: Payless Building Supply _ t <br /> FACILCIY ADDRESS: 532 E. Lockeford St.Lodi, CA 95240 <br /> I. 350 gallon leaded g asoline <br /> TANK ID #39 - 61 Tank Description: <br /> FPA Site # CAC 000974456 t <br /> ••►►al/faalaoo•11•!14oara#r orf 00la6o4 o 111 a a 6001/aratoalllfaf!llaaarloa-f 11a!lorl}o!!!r!!f!!!ol!!a!!!!f!!!!• <br /> F SECTION 2 To be filled out by lank removal contractor: #r <br /> Tank Removal Contractor: JIM THORPE OIL, INC. DSA RICH-MART CONSTR. <br /> Lodi , CA Zi . '95241--0357. <br /> Address: 351 N. Becknian Rd. P. 0. Box 357 City: P <br /> Phone #: (_I09 } 368-6175 Date Tank Removed: <br /> ' oaf•aafaoo•ffala##aal•111a//faalfalraaa!lafraailalrrooa!•Il!}!•!r!!!f!!!!!t}}!!!a!!!!!!!!r!!!1!!!0!!!!!!!!l - 1 <br /> SECTION 3 to be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. DBA RICH-MART CONSTR./Nor-Cal Oil <br /> Hauler of rinsate <br /> + Address: 351 N. Beckman Rd. P. 0. ,Box 357 City: Lodi , CA gyp:: `,° 95241-0357 <br /> r Phone #: {_ 209_} 368-6175 <br /> y signing below that the tank has been dernntaminated In an approved <br /> Authorized representative of contractor certified b <br /> manner as required by the State Department of Flealth Services. <br /> all T(lle• Vice-President <br /> Tank is free of all sludges and hydrocarbon vapors upon deliverjylaato Schnitzer Steel <br /> l fffafaara•farlraaar!!a!lrlraraar•lrrara+aarraaraalrrlr!llrrrlrlarsraa!•*ara*! �!!!aal,lr}rarrrr!!r irlrr! <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment,storage, or disposal facility <br /> accepting tank and/or piping. ; <br /> Facility Name: Schnitzer Steel Products <br /> s Address: 12000 Folsom Blvd. City: Rancho Cordova Zip:' :'95742 R I <br /> Phone #: ( 916' ? 985-4810 <br /> l <br /> Date Tank Received: <br /> mac/ <br /> Signature• Title: i <br /> I <br /> •••.•••♦r••r•a•••••raa•aaar••allrraa•r••ra+rar•a•a•ara•raaarr/!!•aaaaaaaalalalrrrar!lrillraalaarr►lraalalr <br /> Page 10 } <br /> EH 23 049 (Rev 2/8/91) wp <br /> A DM.1km d SI"fmTtln Cmmry 11eai1h Cm Sesdces <br /> . E <br /> - I <br /> i <br /> t <br />