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�� � SAIV J0At�2N LOCAs, FiFFs•r.'j'�IS'IZ�IC'i <br />i <br />UrDERCROL"D TANK DISPOSITION TRACKING RECORD <br />• <br />RtttRRRRtRtttRRt*XtR!!Rf!!*R*!*RR!*tRRR**X*tRRRt!!RR*tRRRRRRR**lRRR*RR******f*!*RfR!!RR**RR <br />SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with its site Identification number. The Tracking Sheet is to be returned to San <br />Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br />� <br />recycling facility. The holder of the permit with numr not_i below !s resLR gibl for <br />aO6urina t_►ut hi fo_*m i 4m.^leted a UtUK _ <br />FACILITY HAW: Valley Auto Repair <br />FACILITY ADDRESS: _4055 N. Wilson Way, Stockton, CA <br />000 <br />TANK ID 139- �2.35� - dZ _ / gL � 9 cz ,tr C14c UdU(S��SzS <br />!!t!!flRflR*XR**!RR*lRRRlRtR*R*R**X*RXRXR*R!R! *RXRRf!*RR*RRX **R***R**RR***R*RRR*lRRRRtRR* <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: 11M THORPE 01L, INC <br />Address: 351 N. Beckman Road, Lodi, CA 9'.)240 <br />_ Zip; <br />Phone#: _(2M 363-6175 <br />Telephone: (—)--Date Tank Removed Zia el <br />!R!!RtlR!!RlRf*RRRfRRR*!R!!fA'R*ft*fRR!*R*XR**XRltX!**R**!XR*RRlRXR!*!*!l7tR*flRRttt*f!lRtRR!! <br />SECTION 3 -Tb be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: JIM THORPE OIL, INC. / Nor -Cal Oil, Hauler of rinsate <br />Address: 351 N. Beckman Road, Lodi, CA Zip 9540 <br />'209 368-6175 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated In an approved manner as my be regulated by Department of Health Services. <br />Vim -President. <br />SIGNATURE TITLE -- —'—� <br />RRlRltR!*lRRR'RtltR!*!*!!R!!X!R*!*!RRlR*RRXRRRR*RRR**R**RR*XR*!*RRX**XRRRRRRl R*RRRRlRR*XR lXR <br />SWrICH 4 - To be filled out and slgned by an authorized represnetative of the treatment, <br />storage, or disposal facility accepting tank. <br />Facility Name Schnitzer Steel Products Co. <br />Address: 12000 Folsom Blvd <br />Date Tank Received: ` o�l/„ 1c <br />AVPHORIZED SIGNATURE <br />RRRRR!!**lltRX!*fRRtRlRRlRRR*!*Rtt!*!fR*RlXR*RRR!*! <br />RK 23 049 12/88 <br />MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. <br />_Zip: <br />1: 916 985-4810 <br />•r i rle: <br />!XRlRlRlRlRRRRf R!!!*!R*Rl RRRltRlRRR! <br />AFFIX PROPER POSTAGE. <br />SAN JOApUIN LOCAL HEALTH DISTRICT <br />AT'IN: LWERGROUND TANK PROGRAM <br />P. 0. BOX 2009 <br />STOCKT N, CA 95202 <br />