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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SITE NL'NMER 8 <br /> SECTION 1 -Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its-Site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: FORT OF SIUCKTCN EPA #CAL 000041551 <br /> FACILITY ADDRESS: /� 2201 l4EK WASH INGTON STIEET, STO=N, CA 95203 <br /> TANK ID #39 -L O1-_o 8 TANK SIZE: 250-1000 G PREVIOUS TANK CONTENTS: GASMNE <br /> SECTION 2 -To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL INC. -- <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone#: 2( 09 ) 368-6175 Date Tank Removed: Jan 5, 1999 <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tan}: Decontamination Contractor: <br /> JIM THORPE OIL, INC. <br /> Address: <br /> 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> 209 368-6175 <br /> Phone#: (_) <br /> Authorized representative of contractor cenifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Martin Thorpe <br /> Tide: ttP Signature: (B <br /> ate <br /> 1/4/99 <br /> ## ##t##*###t###o####Y#######�{#######,,#,#I##h#,,#,i#***###h########**#########,#[##*i t#�##to#$c{,#sitz*r##Steel####*##* <br /> t LTb rf4 - o be signed an�da�ed�by'dd a1x17dt�e�rYe��s�t��Ge� c���tr�a�e�[�stvorage, or'd[sposag facLltry <br /> accepting tank and/or piping. <br /> FacilityName: $ H <br /> Rancho Cordova , CA <br /> Address: 12000 Folsom Blvd. City: Zip: 95742 <br /> Phone#: 91( 6 ) 985-4810 <br /> Date Tank Received: 6 (o C7 <br /> �2 (�erj y <br /> Name. Title: �le� 0 6 Signature: Date l (t <br /> EH 23 046 (Revised 9/11/96) Page 10 L <br />