Laserfiche WebLink
SAN JOAtt ,,nN COUNTY PUBLIC HEALTH SRRVI,,f <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE 'TANK DISPOSTPION TRACKING RECORD <br />♦####+###++4f♦F#!i#i#4!#f4#f#i+##+ff+li###4+f##!##++####+4#f1#f444+#f#+!l►1111►1►1►IM►►1114111111111111111 <br />SECTION t - Pnblic Ifealth Services Environmental Health Division Tank Tracking Sheet shall accompany each lank affixed <br />with its site irlendncation number. The Tank Tracking Sheet is to be returned to Public Health Services Envirortrrtentai Health <br />Division wilhln 30 day. of acceptance of the intik by the disposal or recycling facility. The permit holder is responsible for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: Rainhrc Market E.P.A. # CAC 000�44R16 <br />FACILE FY <br />TANK 11) A39 - TANK SIZE: 5,000 gals. PREVIOUS TANK CONTENTS: gasoline <br />♦aasaaaa#!♦w#a###waa###fi##!f#++++###+#+i##########f#4f###f#f##f###iii###►####!####!#!#####!+#######f4##### <br />SEC'17ON 2 - To be filled out by tank removal contractor: <br />9199 S. Airnort Way. Stockton, CA 95206 <br />tank Removal Contractor. Jim Thorpe Oil Inc. <br />Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodir CA zip: 9 524 1-0357 <br />Phone, #: (_ 209 ) 368-6175 Date Tank Removed: <br />aaawaaaaaa#as##+#ww#+a#####f#i#+##f##!+#+##wraw#♦##f##fif##+lwf##4ff####!+#i#!!4!+!!#!!!!!l►11►l11#1!1!!1!! <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor. Jim Thorpe Oil, Inc. <br />Address: 351 N. Beckman Rd./P.O. Box <br />Phone I: ( 209 ) 368-61 <br />City: Lodi, CA <br />Zip: 95241-0357 <br />Andmrhtrd representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br />minter as required by Cal EPA. <br />Name: <br />Title: Signature: Date <br />4Yank' is+f#ree+nf#a#fi##sludg#e!s# an <br />SFCTION 4 - To be signed and dated by an <br />accepting tank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />Address: <br />12000 Folsom Blvd. <br />phone A: ( 916 ) 985-4810 <br />Date Wank <br />or <br />Rancho Cordova, CA <br />City: <br />Name: Title: Signature: <br />Ell 21046 (Revised 9/11/90) Page 10 <br />Zip: 95742 <br />