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= SAN JQAQbt N LOC..AL 1.1$"..AL.'I'fi s►d$ v 1 <br /> t I" TAW DISPOSITION MAC7KIN0 RNMRD <br /> RttH ffHRRtttffttt!ltfftttRftlRRfttltttRftlfltlfflYYRRttRlfYfRRtlIRlttt!!fltt7a�Gtf��GYlH <br /> Si«.TION 1 - The San Joaquin Local Health District's Tracking Sheet willace hank <br /> affixed with Its site Identification number. The Tracking Sheet is to bet K " <br /> Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. The bolder of the permit wit'b number noted below is resQ=Ihle for <br /> tnamrina th"t this form Sa co"etsd and returned <br /> IACILITY NW: Henry Wolters & Son - Charlie Skobrak <br /> FACILITY ADMMSS. 331 N. Aurora, Stockton , CA 95202 <br /> 1 - 500 gal tank <br /> TANK ID 139- Y/S - C / EPA Site k CAC 000195273 <br /> fRRtfttY!!ttlt*ttftftltlf!lttttfltfft*ttRlttftRfltltRtlftflttff}Rttttff}R*tttflfftftff}fflt <br /> MMION - 2 - To be filled out by tank removal contractor: <br /> I** Remaial Contractor: Jim Thorpe Oil , Inc. <br /> Frye: 351 N. Beckman Road , Ludi , CA Zip: 95240 <br /> ne <br /> Pho #: (2097-467-4787 <br /> Telephone: ( ) Date Tank Removed: <br /> Ht1fHflRttlfttttft!!tflt!!f Rftffflttftttt Rltfit!•RtttHRHMf lttYtlfffltRf!lHtHYltfittlY <br /> NOF" ON 3 -To be Eilled out by contractor "decontaminating tank": <br /> T * Decontamination" Contractor: Jim Thorpe Oil , Inc. / Nor-Cal Oil , Hauler of rinsate <br /> Addreast 351 N. 3eckman Road , Lodi , CA Zip. 95240 _ <br /> - Phonal: <br /> Aathmised representative of contractor certifies by signing below that the tank has been <br /> deaentaminated in an approved manner as may be regulated by Department of Health Services. <br /> SI MAIM AND TIT1.11 <br /> ftHRtHfltRRttRftttRtRt!!R!tltfltftYR*tlRtttRtlf*fRftlRtRRttfRRtRYfYRf!lftRttfttRffRltR!!t <br /> SIMCM f - To be filled out and signed by an authorized repzeenstative of the treatment, <br /> stocaga, or disposal facility accepting tank. <br /> SZ P6' i Xv',16ec is <br /> x <br /> Address _ /Jc�� G�ls��h /�/vim �� c41� ���do �u C% gZip: 9 5-6 "7& <br /> Phone/: <br /> Me 'Aenk Received: <br /> At11410RIZW SIGNATKM AND TITLE <br /> ftfRtHYflRRttttfttf!ltltRltlRf}RHHt}eHR/tRt*!Yt}R}Rt*lYRtftf}RRYR}R}}RRtf*lt/f*}tHtt!! <br /> IN 1) 049 12/81 <br /> WULM IN07RVTIOM: MED IN HALF AND STAPEA. AMX PROP Rt PQNM=. <br /> SAN JQh=N LOML HULTH DISTRICT' <br /> ATTN: U OUNM M TAWK PRDOItAH <br /> P. 0. BDX 2009 <br /> 87q(R'=$ CA 95202 <br /> Y <br />