Laserfiche WebLink
PUB �;• ..� <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.IJ.,M.P.H. •'•, <br /> Health Officer c'' • `* <br /> 1L+F � <br /> 1'.O. Box 20o9 • (1601 East Hazelton Avenue) • Stocltton,California 95201 <br /> (209) 468.3400 <br /> UNDERGROUND 'TANK DISPOSITION TRACKING RECORD <br /> lRlRR!#•tR#«4t#tRlRt#tR#t##t#R#R#tt#ltRR#!#itRtR##RARRk«#R##########RR##«####«###tiRR#k##«#####«#######«#k« <br /> heet will accompany each <br /> SECTION 1 - Public Health Services Tracking Sf acceptance ttdlidentification its site <br /> ance otfk <br /> the taby the disposal or recycling <br /> Tracking Sheet is to be returned to Public Health Services wilirin 3d days-o p <br /> facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: The Port of Stockton <br /> FAC1111W ADDRESS: <br /> 2201 W. Washington St. Stockton,CA <br /> TANK ID #39 - <br /> 0 'Z93 Tank Description: 600 gallon gasoline <br /> !!#4ttR#t#R###RRt#RR#tR##!k♦#t««!!#t«!«#iRRR#####R«EPA #:#ei##«*AC *6«#«###«##'###«««###k#'##«## <br /> SECTION 2 - To be filled out by tank� THORl'emoval contractor: <br /> o trL,oINC• DBA RICH-MART CONSTR. <br /> Tank Removal Contractor. <br /> Address. 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241 -0357 <br /> Phone #: (__209 ) 368-6175 Date Tank Removed: <br /> SECTION 3 - to be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIMTHORPE OIL, INC. DBA RICH-MART CONSTR./Nor-CalulerlOT rinsate <br /> Address: <br /> 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 20� 36$-6175 . <br /> d by signing below that the tank has been decontaminated in an approved <br /> Authorized representative of contractor certifie <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 hydrocarbon vapors upon delivery to Schnitzer.Steel . <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 /> Cit Rancho Cordova Zip: 957'42 <br /> Address: 12000 Folsom Blvd. Y <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Title: <br /> Signature: <br /> ####ttRR####««######!4«i##kik#:►####t«###t#t###t#######k!#ltRR#t!«RtRR►RtR«#!!####«###!########«########### <br /> Page 10 <br /> EH 23 044 (Rev 2/8/94) ►+p <br /> A Division of San Joaquin County iicilth Care Scroccs <br />