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PUBLI9F, HEALTH SER�iICES 45'iF! <br /> ,Q. . <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA MD.,M.P.H. <br /> Health Officer r�i F8'Ar'v <br /> P.O. Box 2009 • (1601 East Iiazetton Avenue) • Stockton, G1lfomla 95201 <br /> (209) 468-3400 <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> •••••ur•r•ur•rrr••••r•,•••,•,•••,•••r•,u,:••r••r•••u,r•r••r,•r,•ru•••••rr,••r•••••••••u••♦•••,•••u,• <br /> nk affixed <br /> ith its site <br /> dentincation <br /> pany <br /> Tracking Sheet Isto returned to <br /> ces Tracking Shefacility. <br /> Public Health Service'et will s within 30 days tof acceptance wof the tank iby the disposal or recycling <br /> facility. The permit holder Is responsible for ensuring that this form is completed and returned. <br /> The Port of Stockton <br /> FACILITY NAME: <br /> FACILITY ADDRESS: 2201 W. Washington St. Stockton,CA <br /> '! t -n � n <br /> Lv� Tank Description: 600 gallon gasoline <br /> TANK ID #39 - EPA Site # CACI 00084P41C� <br /> •..•••••••r•••••...•r•.,r•..:•r.rr.•rr•.•.r•rr„•..•.....r•r•.•r.•. ••r•.. •.. ••r••:••.••...•...•••.•.•• <br /> SECTION 2 - To be filled out by tank removal <br /> c OIL,c' INC. DBA RICH-MART CONSTR. <br /> Tank Removal Contractor: <br /> 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi_ ZIP: 95241-0357 <br /> Address: 11 <br /> Phone #: ( <br /> 209 J 368-6175 Date Tank Removed: 7/v 3 <br /> ••...r••..•r•r..r••,•r.,r•r•rr•••.,rr,r,•.••,r•,..:.•.••rr•r•r•.••,••.•.•.••u••.••••.••.•••,••.•,•,••,u•• <br /> SECTION 3 - to be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL, INC. DBA RICH-MART CONSTR./Haulerlofgill insate <br /> Address: <br /> 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi <br /> _ , CA _ Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized representative of contractor certified by signing below that the lank has been decontaminated in an approved <br /> manner as required by the State Department of Health Services. <br /> Title: Vice-President <br /> Signature: <br /> Tank is free of all sludges and hyddo2r <br /> arbon vapors upon delivery to Schnitzer Steel . <br /> SECTION 4 -To be signed and dated by an nutborized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Cit Rancho Cordon ZIP: 95742 <br /> Address: 12000 Folsom Blvd. Y� <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Title: <br /> Signature: <br /> •.•.•••••••r•••••••.•u•,• •.•..•••.••r•.•r•••,•.•.•..••.•r•.•r...•••.•.•r•,•u„rrr•r,r•••••r,ru•r•,r•r• <br /> Page 10 <br /> EN 23 069 (Rey 2/8/91) W <br /> A Did5lon or San Jmquln County❑eillh Cfre krvteea �, <br />