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%.e <br />FWA <br />SAN JOAQUIIN COLNTY PLBLIC HEALTH SERVICES <br />ENti-I20NNIENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TR.a,CKING RECORD <br />................#.......#........................#.......#.........x...#.r.....x..........................# <br />SECTION 1 - Public Health Services Environmental Health Division Tank Tack lig Sheet shall accompany each tank attired with <br />its site identiticacon number. The Tanis Ttacking Sheet is to be returned to Public Health Services Environmental Health Division <br />within 30 days of acceptance of the tank ov die disposal or recycling facility. The permit holder is responsible for ensurng Stat <br />this form s completed and returned. <br />FACILITY NANIE: Cancun Restaurant Parki <br />FACILITY ADDRESS: 342 N Hunter, Stockton CA 95202 <br />TANK ID #39 � J5-5 q ANK SIZE: `ft)8 0 PREVIO(:S TANK CONTE`ITS: l aa`tort gn cnl i no <br />1Vl3�SA.±I�E}#.......i.##.i####ir#i##ia#i######...................... r##......... <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: JIM THORPE OIL, INC. <br />Address: <br />677 E. <br />Lockeford St. , P. <br />0. Box 357 City: I odi <br />- CA Zip: 95241-0357 <br />Phone .;: <br />( 209 ) <br />368-6175 <br />Date Tank Removed: %/�101 <br />.#....#.....................}............... ......#....#..............#x.....x............................. <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: JIM THORPE OIL INC. <br />address: 677 E. Lockeford St., P. 0. Box 357 <br />Phone.#: (_109 ) 368-6175 <br />Gty: Lodi. CA Zip: 95241-0357 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved-. <br />manner as required by Cal EPA: <br />Name: -TL1 Title: VP Signature <br />#.... ........... .}.....#r...............................#.#.#...........--------- <br />i"an1'c is r'ree'o'a'fi�'s�ud'e55 and h droc rbon va ors on d 1' er C eT. <br />SECTION' 4 - To be signed and d ted by an au�honze� represen�anve oil e reaQXr ara�. tS�� ��sa� act�i <br />accepting tank and/or piping. <br />FaciiiviName: Schnitzer Steel Products <br />Rancho Cordova, CA <br />Address, 12000 Folsom Blvd. Cigc Zip: 95742 <br />Phone #: ( 916 ) 985-4810 <br />Date Tank Receive <br />d <br />: %y'/6A) <br />Name: leu, �l Cl( Title: Signature: <br />G/0 <br />............................#..............................#.............................................. <br />EH 23 046 (Revised 08/13199) Page 10 <br />