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PU LIC HEALTH SI WICES <br /> SAN JOAQUIN COUNTY �` a <br /> N: :t <br /> JOOI MANNA M.U.,M.P H. <br /> Ilalth Whitt <br /> P.O. Bos 2009 • (1601 East ilazchon Avenue) • Stockton, California 91201 �� d <br /> (209) 4683400 <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with Its site Identification number. Ilia <br /> Tracking Sheet Is to be returned to Public I lealth Services wilhili 30 dung of acceptance of the lank by the disposal or recycling <br /> facility. The permit holder Is responsible for ensuring that this form is compicbed and returned. <br /> FACILITY NAME: J MAR - STOCKTON PETROLEUM EPA Site #CAC 001010216 <br /> FACILITY ADDRESS: 4075 E. Main Street, Stockton , CA <br /> TANK ID #Y9 . 39-1667-04 Tank Descriptkrn: 1 - 350 gallon waste oil tank E piping <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. , DBA RICH-MART CONSTR. <br /> Address: 351 N. Beckman Road , P. O. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 368-6175 Date Tank Removed: June 6 , 1995 <br /> SECTION 3 - to be filled out by contractor "decontaminating lank": <br /> Tank Decontamination Contractor: Stockton Service Station Equioment Co Inc - <br /> Address: 808-820 N. Union St. City: Stockton , CA Zip: 95205 <br /> Phone #: ( 209 ) 464-8333 <br /> Authorized representative of contractor certified by signing below that the tank has been decontaminated In an approved <br /> manner as required by the State Department of I1ealth Services. <br /> Signature: see attached Certification of triple rinse Titic: <br /> 'J'an' il sl�ic��e� and h��rofaybon vapors upRn �i�livery <br /> SECTION 4 - To be signed an r Ic by an a t ror ze represet In Ive o ter atrnent, st pa all ��l <br /> accepting tank and/or piping. <br /> Facility Name; Schnit7ar CtPP) Pxyr�_tc <br /> Address: 12000 Folsom Blvd. City: Rancho Cordova Zip: 95742 <br /> Phone C 916 ) 985-4810 <br /> Date Tank Received: J ne 14, 1995 <br /> Signature: Title: <br /> Page 10 <br /> Ea 23 049 (aav 2/8/91) wp <br /> A mlvl,lon of San Joaquin Cou"ry nc•l,h Cur scrvk<r �> <br />