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SA-v JOAQUINi COLNTY PUBLIC HEALTH SERVICES <br /> ENN"MON3fLNTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACFJKG RECORD <br /> Wirttwwl+w4rtraY!#YW}WWii#f#WWWSWwlM!}WMW4M}w}i##lxWMWwW##fawlYrt}YWrtYr}rra#YYWW##aaa W#rtw#++WlW#}fi}#!W!##xina <br /> SECTION I -Public Health Service+EnvironmenW Health Division Tank Tracking Sheet shall accompany each tank affmad widt <br /> its six identification number. Tho Tank Tracking Sheet is to be rerutned to public Health Services Environmental Health Divisio^ <br /> within 30,vs of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> this form is completed and returned. <br /> FACILITY NAME: Joe Omachi Property <br /> FACILITY ADDRESS: 35 Jackson St . - Stockton , <br /> -A.N'K ID 839- TANK SIZE: i PREVIOUS TANK CONTENTS. <br /> wrtxat»»}ri!lawW}WWrtY}w+tr+rt W4MaaY+++WYYYW}#Y»»!+YlM#WWYi#}###iwfWMWM}###}#+W+lW44l4'4a#YWw»#aF+#tW}Wr YY.r«an.. <br /> SECTION 3-TO be filled out by tank removal contractor: <br /> 'ankRemoval Contractor• Jim Thorpe Oi1, Inc. <br /> Address. P.O. Box 357 Clry: Lodi , Zip; 95241-0357 <br /> ?hone A: ( 209 ) 368-6175 Date Tank Removed: <br /> .Y»YwW x#R###WAW WY###}WWWY###WY}xWxYYYMIYY+}}WW#Wrr�YY«+tY.}#Y#ra}++a++#W}WW##i'.t#W#.YWWW4WY}Y#wW+##x#*WWYY <br /> SECTION 3 -To be filled out by contractor"decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil , Inc. <br /> Address: P.O. Box 357 City:Lodi , Zip: 95241-0357 <br /> Phone : ( 209 > 368-6175 <br /> Autbortted representative of contractor certifying through signature below that the tank has been deccnmminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Title: Sigiature: Date <br /> WWYYx#Y#WWiWY•+WW#}WYMYi+WW}WxaYtrY#i!»W}YYa+Y+#F#1"�4fi}a.a+a#a+fW}##x}##xi!!"kWW}##}#i+pliiW4WW WWW#•ifixwwwrtx <br /> SECTION 4-To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address; 12000 Flosom Blvd. Rancho, Ciryf'ordova, LA-ZIP: 951942 <br /> Phone N: ( 916 t 985-4910 <br /> Date Tank Received: <br /> Name: Title: Sigt:a=: Due <br /> YYYYaa##sx#+WW4####i}WWW w##WWW}}}a###t#+#}YYYt Wwr+aa4##antra++.a4WWaYi}Yiw#fwtMY#Y;aif!####W44}ls:Yw##aYY <br /> E4^_3 046 (Revised 08!13!99) Page 10 <br />