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S2uV 17(DE LTIN LOCAL F IEALTF DT STRT CT <br />1111 <br />r.r <br />TANK DISPOSITION TRACKING REOORD <br />SECTION 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 be returned to San <br />Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br />recycling facility. The holder of the permit with number noted below is responsible for <br />ensuring that this form is completed and returned <br />FACILITY NAME er1yZ, D/ LCV/ -,3 <br />FACILITY ADDRESS: 1025 Industrial Way, Lodi, CA <br />TANK ID #39- 1339 _ Ol /�/(,®Q �it�rJa% EPA Site #CAC 000194948 <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor:_ �� j�1���(/�_ ,s��� c). <br />Address: 351 N. Beckman Road, Lodi, CA 95240 <br />Zip: <br />Telephone: ( 209 l 462-4581 Date Tank Removed: 8/25/89 <br />*z*********z*****z*****************x**********zx**x******z***x********zzz*****z**xx***zxz*x <br />SECTION 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: Jim Thorpe Oil, Inc./ Nor -Cal Oil, hauler of rinsate <br />Address: 351 N. Beckman Road, Lodi, CA Zi . 95240 <br />Phone#: 209 462-4581 <br />Authorized representative o contractor certifie "by signing below that the tank has been <br />decontaminated in an approy6d ma r as may be ,egulated by Department of Health Services. <br />SECTION 4 - To be fi <br />storage, or disposal <br />Facility <br />Address: <br />Date Tank Received: <br />/ u ( Vice -President <br />SIGNATUTE AN TITLE <br />** ***************************************************************** <br />1 out and signed by an uthorized represnetative of the treatment, <br />cility accepting tank. <br />SCHNITZER STEEL PRODUCTS CO <br />12000 FOLSOM BLVD <br />AUTHORIZED SIGNATURE) AND TITLE <br />EH 23 099 12188 <br />MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br />v 11/2/89 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT Attn: Jamie Favalia <br />ATTN: UNDERGROUND TANK PROGRAM <br />1989 P. 0. BOX 2009 <br />STOCKTON, CA 95202 <br />ONNEN7AL HEA T' <br />HERMIT/SERVir'r' <br />