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PUBMC HSEWICES <br />SAN JOAQUIN COUNIY <br />J(X;I KIIANNA N.D., M.P.11. <br />Ilealth Offaer <br />P.O. nox 20)9 • (1601 East llazeiton Avenue) 0 Stockton, Callfond2 95201 <br />(209) 469.3400 <br />UNDMIGROUND 'TANK DISPOSITION TRACKING RECORD <br />Vul ION I - Public I lealth Servicca 'Tracking Shect will accompany each tank affixed with Its site Identification number. The <br />'l'lacking Sheet Is to he returned to Public I lealth Sctvicet within 30 days of acceptance of the tank by the disposal or recycling <br />facility. 'I he permit holder Is responsible for ensuring that tills farm Is completed and returned. <br />rACiLTI'Y NAME: MOHAMMED MALIK EPA site #0f0lA'Yi`5�4� <br />rACIIATY ADDRESS: <br />6550 E. Hwy 12, Lodi, CA 95240 <br />TANK 11) #39 - N/A 'rank Description: 1 - 1000 gal EXEMPT gasoline tank <br />sr.f.110N 2 - To be filled out by tank removal contractor: <br />Tank Removal Conlractot: JIM THORPE OIL, INC. DBA RICII-MART CONSTR. <br />Address: 351 N. Beckman Rd. , 11, 0. Box 357 <br />City: Lodi, CA Zip: 95241-0357 <br />Phone #: ( 209 ) 368-6175 Date 'Tank Removed: February 13. 1997 <br />11+•!!•••••••,•••• „ ••,•!•!••••+4144• „ •1••f! „ • „ ••.,..•1•!••,,,•••••,f4• „ ,•• „••4••••44••!••4,•„•,•, 4,• � <br />SrCt'loN J • to be filled out lay contractor "decontaminating tank": <br />Tank Decontamination Contractor: JIM THORPE OIL, INC. DDA RICII-MART CONS TR.JNor-Cal Oil, <br />aider of rinsate <br />Address: 351 N. Beckman Rd., P. 0. Box 357 City: Lodi, CA Zip. 95241-0357 <br />Phone #:( 209) 368-6175 <br />Authorized tepresentative of contractor certified by Sign <br />manner as required by the Sje Uepar tent of f (call; <br />Stgnatnre• <br />Ya'n'k0Ys' <br />' <br />SECTION <br />accept <br />raciiity Name: <br />Address: <br />•• . ♦„sy0• 0• • <br />1 sYuges an 'hyroca...• <br />ed and dated by art notitorize <br />tank anti/or piping. <br />nitzer Steel Products <br />12000 Folsom Blvd. <br />rhone #.- ( 916 ) 985-4810 <br />Date Tank Received: ')-�� tt�i <br />'' Signature: <br />below that the tank has been decontaminated in an approved <br />Title: Vice -President <br />vapors upon l i'very4to 0 C d0g0•440 406.0 40,•40,0 <br />eset tot{rev file treatment, storage, �r d&I-1l�acei- <br />city: Rancho Cordo XIp: 95742 <br />Title: <br />+�•+♦++•+••••,••1••••+,••sl••••••,•+,f•••,••••1••♦4444•• N +„ ••,•,••,••••••,••l,,,,,4•••4 „ 1 „4,••444,14,• <br />Page Irl <br />EN 23 069 (Rev 2/8/91) vp f <br />A b1.hMn of San Jn.mdn (:nunry ilcilrh f..re Scnlce. <br />\� <br />