Laserfiche WebLink
,. . ,. SJLN JCA TI14 LC>C=&TMMAXT.lrl .DI S71R1 4=r <br /> UNDBRUROtMD TAM DISPOSITION TRACKING RROM <br /> , ..A»fffffIttit!ltlRftNtf!*t!lttt*#f!!*tttR*!ttlRRRRlfltlt!!RlRtR#RltRRR#*!1R**tf#11f!!lltR et <br /> O.'4Ti0N 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> Wixed with its site Identification number. The Tracking Street is to be returned to San <br /> Jalguln F Health District within 30 days of acceptance of the tank by disposal or <br /> t0qCling facility. The holder of the Deralt with n)ybe> noted below is resoo:ible for <br /> #yip that this <br /> form its cow ed and returned, <br /> PWILITY NAM. Buffalo Tank Corporation <br /> 1►l=TX ADDIMS. 5709 E. Fremont Street, Stockton , CA <br /> TAW ID 139- /S'/5 - (3 / 1-1 ,000 gal . UL gas tank EPA Site 4CAC 0002/5665 <br /> Rtlftt!!tt*t##tR*!t*i!*R!*!RR*R*R!#t!R**f**tt*R*#tltt!#RRR*t!!t!t*!!f*!##RlftlRt#R*lttt*RRf <br /> MW TION - 2 - To be filled out by tank removal contractor: <br /> lUnk Removal Contractor: Jim Thorpe Oil , Inc. <br /> ilirlae: 351 N. Beckman Road, Lodi , CA Zi 95240 <br /> ,Phone#: 5- <br /> *1000ne: ( ) Date Tank Removed: <br /> -eifrlttlRt!!flttf tltlt#f!#t*!*R#tR##t!R*t*!*t*R!f*R*#lttt*RR#tRltftRt*!*!tt!!lftR!*t!!R!!f!t <br /> L' ON 3 -To be filled out by contractor "decontaminating tank": <br /> T�1Yt Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> Ad�7ceaea 351 N. Beckman Road, Lodi , CA Zip: 95240 <br /> Phone#: (209) 368-6175 <br /> Authorized representative of ontractor ner ies by signing below that the tank has been <br /> 460ontaminated in rn r as ma regulated by Departxrnt of Health Services. <br /> i <br /> Vice-President <br /> / . IGNATURE TITLE <br /> ONION � - / be illed out and signed byn authorized represnetative of the treatment, <br /> "Obarage, or dis l facility accepting to <br /> ftcility Name- ___ <br /> 12000 FOLSOM BLV'U. <br /> Afteae: RANCHO CORDOVA, CA CS7, <br /> Zip' — —'--- <br /> Phone#: <br /> Date Tank Received:_ <br /> AUTHORI SIGNATURE TI—TLE---.- <br /> 00 <br /> ITLE _00 x8 049 12/I8 <br /> Ilm1RUCMOMS: FOLD IN HAL? AND STAPLE. AFFIX PROM POSTAGE. <br /> ;. .,j SAN JOAOI!IN [ACM. HEALTH DISTRICT <br /> ATM: UM)FRGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> SSIDOCTON, CA 95202 <br />