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ti <br /> SAN JOAQ COUNTY PUBLIC HEALTH SER <br /> VPG <br /> EN EIZONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> a+,r,ar+waawwaaaaaw*w�a+alar*raw,,.r*ww*w:=******ire►**r*w*****e►**ra****w*****=*r**r*r•*rw**!#r**rr#########**#### <br /> SECTION ! Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its lire identification number. The Tank Tracking Sheet is to be returned to Public TheHealth��hold"is mspo�bI for <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The p <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: Tuff $oy Trailers E.P.A. #)COX CAL 000035904 <br /> FACILITY ADDRESS: 5151 Almondwood, Manteca CA 95337 <br /> TANK ID #39 �0 TANK SIZE: 1aPREVIOUS TANK CONTENTS: ne <br /> ill+aaaaaa*aaaa*a**awraa****rr*****r*war***aw*r*r***********k ******************!**&*!**********F*********r** <br /> SECTION 2. - To be filled out by tank removal contractor: <br /> Tank Removal Contractor. Jim Thor e Oil Inc. <br /> Address: l 11. Beckman Fid./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> .3 <br /> Phone #: ( 209 ) 368-6175 <br /> Date Tank Removed: � <br /> +.aa+ata*taaaa awaaye*aa**wwf**rwr**w*w**a*!r**r****r*rw**:wan*tr*rrfa***!ea**rf**rrM!*rrslok#f*ok#Rrnkfr**ele elr#i+lr*rk+k! <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor. Jim Thorpe Oil, Inc. <br /> Address: 351 Id• Beckman Rd./P.O. Box 357 City: Codi, CA Zip:95241-0357 <br /> Phone #: ( 209 1 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> �[7 Sign Date e.2 � a-1 <br /> Title: � # ,R <br /> a ..: a,+*. a+*a. w* ,►♦w*w+ra** •� ,y* **ekr#= waw*>.*****w*r*rrw=at►�I 1 v� 1/w L�S�*,hn y i*r*$l.ee Ir*r,►*** <br /> "anCa Is reR o a r s cages ani '�yycrocarion vas3ors upon 0 Q Z <br /> SFC'I'lUN 4 - To be signed and dated by an authorized representative of the treatment, stn age, or tsposalactltry <br /> accepting tank and/or piping. <br /> Facility Name: Sclirlitzer Steel Products C <br /> Raricho Cordova, CA 1 <br /> Address: 12000 Folsom Blvd. City: Zip: 95742 <br /> Phone #: ( 916 ) 98++5-4810 <br /> Date Tank Received! <br /> Name:©dfl. l-. lY (iDc` _Title: dLaS��� Signature: <br /> Date <br /> a+a+++++awn a a+�+airaawtaww+rrw*a**rwr#ww*�iwf,Yw*=*w:*ewe*�*•k*~awr w*r,Yra*=�w*wrr***fk*r*ww#wwAr*r***r*w***eY*.er <br /> Ell 23 0,16 (Revised 9/11/96) page 10 <br />