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SAN JC]Ao I N I..CN Al<_. HmAL.T I S'IT;t I c!r <br /> UNDE RGtOL14D TAW DISPOSITION TRACKING REMRD <br /> t*�ssxx�e*xxxxx*xx�rxitxxxx**x**x*xx*xx�xxxxxxx*xxx*xiexxxxxxxxxxxx*xxxx�ex**x**txx�*xt*x**�xxx* <br /> SECTION 1 - The San Joaquin Loral 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 /> recycling facility. <br /> wring that tbi f-gim is camoleted and returned. <br /> FACILITY NAME: Sav-Trac <br /> FACILITY ADDRESS: 4546 N. Wilson Way, Stockton, CA <br /> TANK ID /39- I - 1 1 - 8,000 gal . Diesel tank <br /> x*rtxx****xxxxxx*xxxxx*xxx�r�rx**xxxxx**xx***xxxxxxxxxx***x�*xxx�xx*x*xx*rrx*�r*xxx�x**x*�rxxxxx* <br /> SEC`T'ION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 351 N, Beckman Road, Lodi , CA 95240 Zi <br /> Phone: p(2 363--6175 <br /> Telephone: { ) Date Tank Removed: <br /> t*x*xxx*xx�rxxx*xx***xx�r**x#�t*****:kx*xxx*�rxxxxit*****x***ir****x**x�txf�x*x*xxx�t***�r*t�xxtxx*iexxx <br /> SICT'ION 3 --To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor- JIM 'THORPE OIL, INC. / Nor-Cal 0il , Hauler of rinsate <br /> Address: 351 N. Beckman Road , Lodi , CR Zip: 95240 <br /> Phone#: (209 368-6175 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> Vice-President <br /> S I GdAIM AND TITLE <br /> xx***xxxxxxxxxxx�r,r*xx;sx***x**xxxxxxx*xxxxxx*xxxxxxxx***xx*sr*�txx*x***xx***xxs*********xxx*xx <br /> SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name <br /> Address: Zip: _. <br /> Phone#: <br /> Date Tank Received: <br /> AUI14ORIZED SIGVATUPE AND TITLE <br /> x*�**xx*�txxxxs*xx*xxxxxxxxx**xx*xxx+�**xxxxx�rxxx+�xx�rxxx*xxxxx*xxxxxx*xx�e�rxx�rxxx**x***�cx�e*xxx <br /> AH 23 049 32/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALE" AND STAPLE. AF'F`IX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL REALTH DISMICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOK 2009 <br /> STOCKTON, CA 95202 <br />