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.ii <br /> SAN JOAQUI COL?ITY FMIC HEALTH SERv?CES <br /> EhN'IlOhl,M,4T.iL HEALTH DIVISION <br /> LjNDERGROLN;D STORAGE TA-VK DISPOSITION TRACXING RECORD <br /> #YYrnYY#.#WrtYyY*..*.*....#i.F#Yxxi#x##W'M/#diff##W iYRYFT#F##?•Y#.R#..........A.**........*:}ii...**...i...#n. <br /> SECTION t -public Health Service+ Environmental Health Division Tank Tracking Sheet shall aceorapeny each tante affixed wick <br /> i�si a idenri icat:on number. 'hp Tank T xcicng Sheet is to be rerstted to Public Health Se^=cos Envlroanen al Healk Dthsic <br /> Wnhw -V of acceptance of <br /> the tank by the disposal or recycling facility. The permit holder is :espo:s:bte for=w-itt;$a; <br /> this`orm is completed and retar:ad. <br /> North Stockton Auto Service CTJ¢�G/9L 000��/Z�,j 7 <br /> 7ACILI7Y NAME,: <br /> r-ACiL1TY?.DDRESS. 8709 N. Davis Rd. , Stockton, CA 95209 <br /> ID#119_ T.MNK SIZE: 550 PREVIOUS TAN-r:CO`,n.NTS.Waste Oil <br /> •I#Jain#i##Yii,R#iFY#YRYJwJ#YYYYYY.YJJW YW YY#ixwMxYYW#}iFwiYYW#}#RRWJ'Fi.tx.i.}Y}i#YW#ifixJYaJ#it}'.#W M,Y.YnY.JJRJ <br /> SECTION 2-To be filled out by tank removal contractor: <br /> 'ankRemoval Contractor Jim Thorpe Oil, Inc. <br /> Address: <br /> P.O. Box 357 Cir: Lodi , Zip: 95241-0357 <br /> ?hone e: ( 209 ) 368-6175 Date TaaQ Removed: <br /> +}YW.....###WWi.ia,#s##.##xiq Ow##.........#RiYi}urtrrw n..Ywa.W..Yn.YiYa.iWJ#YiiY'i#K'.YYl+.#FYWWYYxfs.Yc#......l.. <br /> SECTION 3 -To be tilled out by contractor"decontaminating tank": <br /> Tank Decontamination COS..-actor: Jim Thorpe Oil , Inc. <br /> address: P.O. Box 357 City Lodi, CA Zip:95241-0357 <br /> ?hone 9: ( 209 ) 368-6175 <br /> .auinararJ represeatadve of contractor ceritying through sienarve below &.at the tank hasc=deccntaminated as appteved <br /> manner as rccluired by Cal EPA. <br /> Nam.; Richard ThorpeTide: Contractor Sigaamre: Dare <br /> YYV Yx#.W#'JIFi.Y}##F i#..!.#WVF###xiY{ixv#i#FF.w+�Y}.MY yq,YxYJ.Ri'+..W.W xYx'X%:Yiii#MY[:IIYi}#Y#i.6YYi Yki#iY W#xx FraiJif n <br /> SECTION 4-To be signed and dated by ar,authoraed representative of the treatfcent, storage: or disposal tacilin- <br /> accept ag tank and/or P-Piag. <br /> Fac{lin tiame: Schnitzer Steel Products <br /> Rancho Cordova, CA 95742 <br /> address: 12000 Folsom Blvd. Ciry! Zip; — <br /> Phone 0: ( 916 t985-4810 <br /> Data Tank Received: <br /> Name. Titles: <br /> Sig�3:re. Dart <br /> .#.•.•JxYxiWY}WJ#Yi.#####..Y#Y.Y##.....Y .......WYWxN.W.........#Y#.......Y+...•• <br /> E3_2 046 (Rtvised 08'i3!99) Page 10 <br />