Laserfiche WebLink
SAN JOAC IN LOCAL 14W.Ar rr" ►I srrRI CT <br />Uip"OUiD TAN( DISPOSITION TRAaING RaMRD <br />11ttlRltlRRRRt#!RtltttltlRltRftlRfRtttf tRA##tAttl141ttlRtttE RltfRRRRltRtlltff#RR RRtIMtttttRRR Rt <br />RMTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with its site identification number. The Tracking Sheet is to <br />Joaquin Local Health District within 30 days of acceptance of the tank )� <br />recycling facility. Tb holder_of the permit w:fh nava& - ,, -A ,._,—. <br />- - SEP 21 1989 <br />►AGILITY NAME: Formerly: Lodi Lumber <br />FACILITY ADDRESS: 1025 Industrial Way, Lodi, CA E <br />TANG ID 139- %��? - c! EPA Site #CAC 000f&W1 1989 <br />!!f!!ttlRtttltttttf ttRt!lRtRtERR!!t!t*lRRRlR1RRRtlR**!*!RlttlR!**R!f***� *..*!��,e*f*t�eR!R****!I <br />BSI.'fICN - 2 - To be f i l led out by tank removal contractor: t� 1 p�F�ON'MENTAL HEALTH <br />Tank Removal Contractor: <br />Jim <br />Thorpe Oil, <br />Inc. <br />Address: <br />351 <br />N. Beckman <br />Road, Lodi, CA 95240 <br />Telephone: ( 209 )462-4581 Date Tank Removed: fb 5/&y <br />lRRRRRIttRtRt!#R#ftlf!!tlRt!!tlttt!!!R!!!t!t!R#tRtlR#RIRt!ltRR!!t!!!lttftttlR!ltttttRf!lftt <br />BOCTION 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" contractor: Jim Thorpe Oil, Inc./ Nor -Cal Oil hauler or rinsate <br />Lodi, CA <br />95240 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in an approved manner as mss be pm <br />qulated by Department of Health Services. <br />f!tlfRlt##RR#!###tt#!!!#!Rt#!##fR##tFl Rt#!R!#R!!!R#ttlR#RlRRRt#RBBB###RRRtRRttlttf tRR#RttRtt <br />SRCTION 4 - To be filled out and signed by an authorized repreenetative of the treatment, <br />storage, or disposal facility accepting tank. <br />laeility Nage Bear River Lake Resort <br />Address: <br />40800 Hi <br />88, Pioneer, CA 95666 <br />Date Tank Received: September 7 <br />AUT41mucD SIONMlm AND TITLE <br />tRRRltltltttRfRt#tttftttfR!!ifRtRR!!lRt1!lfftAR!ltftRltlRRRfRR!ltRt Rf Rf tRlRltRRtleR!ltRRttlR <br />IN 23 049 12/11 <br />MAILING INSTRU.`1TONS: nLD IN HALF AND STAPLE. AFFIX PROPER POSTAIB. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />ATTN: UNDERGROUND TANK PROGRAN <br />P. O. BOX 2009 <br />STOCKTON, CA 95202 <br />