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PUBLIC HEALTH SERVICES �R� Q <br /> SAN JOAQUIN COUNTY w :s <br /> JOG]KHANNA M.D.,M.F.H. <br /> Health 011ka <br /> P.O. Sox 2009 • (1601 East llazetton Avenue) • Stockton, Callfoada 95201 <br /> (209) 468.3900 <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> llriMMMiMrl;iliilrlr•rllrrrMrllrMiN4Mr!lirrililirllrirlrlNMiirlMirlriMli!lMMI!llNirrlNrrlrr <br /> SECTION I -Public Health Services Tracking Sheet will accompany each lank affixed with its site Identification number. The <br /> Tracking Sheet is to be returned to Public I lealth Services w!4&30 du of acceptance of the tank by lite disposal ar 10cycifng <br /> facility. The permit holder I$ responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: Port of Stockton <br /> FACILITY ADDRESS: 2201 Washington St. Stockton, Calif. 95201 <br /> TANK 1D #39 - G = 0 Tank Description: 1- 2,000 gal• regular asoline <br /> rMsiisssl+rsilrMrrralrrillrsiMlrsliss!lrMlsMiil!liMlrillrrliiirriMrlllrrMsiMrMMisrrrrislMrrrrr <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil Inc./ DBA Rich-Mart Construction <br /> Address:Po. Bx. 357 /351 N. Beckman Rd. City: Lod i Zip. 95241-035 <br /> Phone #: 2(d9) 368-6175 Date Tank Removed: <br /> IrlrrMllMrrilriMMi•i•irllrr!!llirrlMMiMMrrri!!M!!!Ml!lrrM!!lllrMliiririMMl•lMirNirMr•►MM <br /> SECTION 3 - to be filled out by contractor +Thorpe 10i1lnI tan /DBA Rich-Mart Construction <br /> Tank Decontamination Contractor: <br /> Address: <br /> Po. Bx. 357/351 N. Beckman Rd. City: Lodi Zip. 95241--0357 <br /> Phone #: ( 209 368-61 <br /> Authorized representative of contractor certified by signing below that the tank has been decontaminated In all approved <br /> manner as required by the State Department of health Services. <br /> Title: <br /> Signature: <br /> MrriirlrrrrrrrriMriirrriMlMrlr!l++MillirMMrMrMiiililirilrrlrirrlilrrMMrrrMriiiliilirrrMMrrMr <br /> SECTION 4 -To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepplingg lank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordo Zip; <br /> Phone #: ( `16 985-4810 <br /> Date Tank Received: <br /> Title: <br /> Signature: <br /> rsMrisrrsirrrrrsrsrrrrssrrMsrrr/rlrMrrrrrasMiM!lrrMMrrlMlMlirs!lMMrlMirMsrrirMsliirrMsrissi <br /> Page 10 <br /> En 23 049 (Ray 2/8/91) WP � <br /> A Dwian or San Joaquin Countyud!licuc ser"' <br />