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PUBL1_ __,, H1;-C'llrl H SLR"ICES ,;Rift .. <br /> Y?. �.� <br /> SAN JOAQUIN COUNIY r` <br /> c <br /> h; <br /> JOGI MANNA M D.,M.P.H. <br /> IWilli OfIke •'r �* <br /> P.V. noa 2109 • (1601 E211 Iludtnn Atrnue) • Stockton, Callfurnh 95101 4t1klSA'i <br /> (tog) 4G0"3410 <br /> UNDERGROUND '1'ANK DISPOSI'T'ION TRACKING RECORD <br /> •r•rr•rrrr••••r•rr•r•rrrr r••r•••••rrr•r.r••rr••rr•••r•r•r••••r••••rrrr••rr••r•r•••r••r•••r••••r••••••••••r• <br /> SPA ION I - Public I lealth Services 'I"rocking Sllcel will accompany each lank affixed with Its site Identification number. Vie <br /> I rarking Sheet Is In he returned to Public I Icallh Setvlces whhln JII dnys of acceplance of file lank by the disposal or recycling <br /> hdllly. 'I he permit holder Is responsible for misoring that this form Is completed and returned. <br /> FACILITY NAME: Indpendent Trucking Company EPA # CAC 000979040 <br /> PACILI I Y ADDRESS: 1145 W. Charter Way Stockton, CA 95206 <br /> 'I AUK ID A'39 - 5DSW(, 67J -Dank DescrlpUon: 1 ,000 Gallon (gasoline) (diesel) (waste oil) <br /> ••r•rrr r•rrrr..•.••.r.r••••rrr••rr.•••••...••r••.rr•.•••r•••.••.•.•rr•rr••••••rr•rrrr••r••••••u�••r• •• <br /> SIiCI Ir"IN 1. - '1'u be Tilled nut by lank removal nndlaclor. <br /> Innk Removal Contractor; JIM THORPE OIL, INC. DBA RICII-MART CONSTR. <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CAI / Zip: 95241-0357 <br /> Phone d': ( 209 ) 368-6175 Date Tank Removed: <br /> rrrrrrrr•r rr r,•rrr•r•rrrrrr•••r•rr•rr rrr••rr••r•rr•r•rrrr•r•r•r••r•r•r•••••r••rrr••n••••••••••n•n•••••rr <br /> I <br /> SP(:l ION 3 - to be filled oul by conlraclor "decontaminating lank": <br /> Innk Decontamination Contrnctor: JIM 11101111E OIL, INC. DBA RICII-MART CONSTR./Nor-Cal 011 <br /> au er of r INS <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City. Lodi , CA Zip: 95241 -0357 <br /> Phone N: ( 209 ) 368-6175 <br /> Authotleed represemallve of conhnctor cerltfied by signing below that the lank has been deconlaminaled III an approved <br /> manner as required by the Slate Department of I Icallh Setvlceas. <br /> Slgnnhne: ___ CIIIe: VP <br /> '(46104; <br /> r• •r ,r ••••rr ••• . ,rr.••r. rr••.r•r• r•rr••rrrirrr•.r•r• r .•••a ••• • r•r•••••u••• u•••••• <br /> tank fs free oroll al Sttj ges an((1lydrocarlton valnors ur#on diJlvery to. S'cFnii�zer Sftel�� . <br /> SL"CI ION 4 . To he signed and dated by an nu11101hed reprise Inllve u the Irealmcnt, storage, or d sposal ac ily <br /> accepting lank and/or piping. <br /> Pncilhy Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordo Zip: 95742 <br /> Phone N: ( 916 ) 985-4810 <br /> Dale Innk Rece Q <br /> Slgnalure: Thle: <br /> r•rrr•.•r r•r. .•••• �• .••••..•r.•r•r••••••.•r.••••r••r•••.r•rr•••rr••r•r••••rr•r•r•••••rr••••••••r••r•••• <br /> Page 10 <br /> IR 23 049 (Rev 2i0i91) up <br /> A Uldhlnn d S+n In•TAn rmmq Ile rhh Urt Ser.(«e <br /> �J <br />