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PUBIC HEALTH SlWICES <br />SAN)OAQUIN COUNTY <br />JOGi KHANNA M.D., M.P.H. <br />lralth Oiiker <br />P.U. Oox 2009 • (I(foi East Iluelton Avenue) • Stockton, Gllfornia 95201 <br />(209) 468.3400 <br />UNDERGROUND 'TANK DISPOSITION TRACKING RECORD <br />•.••.••••••••••i••••.•...••/••••.►.••111••••1•f1.1.11.11•••44••4N•11••••••••N•1•••4.4••••111414.4••1••••• <br />SCa.; MON 1 - Public I lealth Servicc%'l4ncking Sheet will accompany each lank affixed with Its site Identification number. The <br />'irackhtg Sheet Is to he rehitned to Public 1 lealth Service.% within JO days of acceptance of file tank by lite disposal or recycling <br />facility. The permit holder is responsible for ensuring that this form is completed and returned. <br />rACiLITY NAME: Mohammed Malik <br />rACILTi'Y ADURESS:CA 6550 E. Highway 12, Lodi, CA 95240 <br />TANK Ii) #39 - 001 'Tank Description: 200 gallon <br />•i••••••f•••1.4•••••••••11•••••••/•/•••••••••11111141••••11••411•►1•••11f••11••••••••••••••••••/•1.0.01.1• <br />Sr -(A ION 2 - To he filled out by tank removal contractor: <br />'innk Removal Contractor. JIM THORPE OIL, INC. DBA RICII-MART CONSTR. <br />Addles: 351 N. Beckman Rd., P. 0. Box 357 <br />City: Lodi, CA Zip: 95241-0357 <br />Phone #: ( 209 ) 368-6175 Date 'Tank Removed: 1/8/97 <br />•••••••1•••11••••••••1••1••1.1.1••11•••••••••••••••••1•••••4 N ••If1♦•1.1••01••••1••••••••••••••1141•••••••• ' <br />r <br />SEc I ION 3 - to be filled nut by contractor "decontaminating tank": <br />'rank Decontamination Contractor: JIM THORPE OIL, INC. DBA RICII-MART CONSTR./Nor-Cal Oil <br />Hauler of rinsate <br />Address. 351 N. Beckman Rd., P. 0. Box 357 City. Lodi , CA Zip.95241-0357 <br />Phone tY: ( 209) 368-6175 <br />Authorized repro.%enladve of contrnc or ce titled by signing below flint the tank (las been decontatninated in an approved <br />manner as requl►%d+yjhe/. tateAA1jnt of health Services. <br />Signntu <br />Title: resident <br />• •• •• •. ..••• •• .•• . •••••••• •••••1••1 ..•..••.f:•.••.•••f • 1••1••• ••• • ••10010.1•••• ••1N 10• <br />Tank is tree o� a t s 1•uages and Vydrocarbon vapors upon deft very 0 5'chf Azer Ste <br />SECiION 4 - Ib he signed and dated by an nuthorlmd represer tntive o file treatment, storage, or sposalfac y. <br />accepting tank and/or piping. <br />racility Name: Schnitzer Steel Products <br />Address: 12000 Folsom Blvd. <br />Phone A': ( 916) 985-4810 <br />Date Tank Received: <br />IN W <br />City: Rancho CordovXlp: 95742 <br />•••••.•••14••••1••♦••••4••4••••••t✓••Ott* .1fIt•♦/1••0.1••so* 0•••/s••••0.1f1f1f 0111f0001••/•f••••••604444#9 <br />Page 10 <br />to 23 049 (Rev 2/x/91) up <br />A 014sinn of S.n jn.Tdn Cawy Ilcilth Cue ScrOcea �� <br />