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I 00 • ` <br />SAN JOIN LOf. AL I- MAIC jPnX SrrR2 x'li <br />UNDBR(XtOUND TANK DISPOSITION TRACKING RECORD P R 1989 <br />Rlff!!tt#ltf YtR**ltlYR*RlxYff*RRRRR!!lfRR**RRlR!!!lRttRR!*RtRttRf 1+*lRR1RlYtRRf *!!!!!!!lRRR! <br />SECTION 1 - The San Joaquin Local Health District's Tracking Sheet Will accanpany'!tank <br />affixed With its site Identification number. The Tracking Sheet is to be retwhdF,�O``San <br />Joaquin Local Health District Within 30 days of acceptance of the tank by dlspoual or <br />recycling facility. The holder o rmlt wl h Apr ppbelow is regR�,�+tii Eor <br />ensuring that this fora-Sa completed and z t„rned <br />FACILITY NAME: LAMMERSVILLE SCHOOL EPA Site ,4C Coo !S 2S - <br />FACILITY ADDRESS: 16555 W. Von Sosten Road, Tracy, CA 95376 <br />TANK ID 139-_ <br />*R!t*!*x*xR*RtRtRtttY*t!lett***YlARltt*Rx''7Rf*Y*!*RRRlf Y*!r*R*RtRf!*R!*Rf lY**!*RRR!*R**!!!ft*t <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: JIM THORPE OIL, INC. <br />Address: 351 N. Beckman Road, Lodi, CA <br />Ip. 95240 <br />Plwnel: _(209 462- 8 <br />Telephone: ( ) Date Tank Removed:__ <br />!Yt**RR tf**Y*RRx***tt*****tRRRRRR***RRR****Rt*tR*R!**RRRt*R**R*Y R!!R*!!t !lfRt!!*tY!lfRYlt <br />SECTION 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: JIM THORPE OIL, INC. <br />Address: 807 E. Black Diamond Way, Lodi, CA Zip: 95240 <br />Phone/: X209 462-458 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontami ted in an approved manner as may be regulated by r*r:artment of Health Services. <br />SIGNATURE'/AND TITLE <br />RRR*RfRlYR*R**R*tYlt!*RRRtR**R*RtR*tRkRRR**1tRR**RR*R**R*!Rt******RR************************ <br />SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br />storage, or disposal facility accepting tank. <br />Facility Nam_- kep c.wJp,) P"jee/1 f; &j <br />Address: <br />Date Tank Received: <br />AUTHORIZED SIGNATURE AND TITLE <br />RR*RR*fR**tRRf***RRRlYRRtR*fR***lRRRlt****RRR*RRtRRttf R**lRRRtYRRtlYtR**RRRlRR**RtRRlt**RRR <br />RN 23 019 12/88 <br />MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTACZ. <br />SAN JOAOUIN LOCAL HEALTH DISTRICT <br />ATTN: UNDERGROUND TANK PROGRAM <br />P. 0. BOX 2009 <br />STOCKTON, CA 95202 <br />