Laserfiche WebLink
S2U-J JCWU:1N LOCAL. JJMAL*I DISTRICT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> xxx*xxzxzxx*xz*z*xxzzzzz*xxz*xxzzzxxxzzxzxxxxxxxxxxxxxxxxxxxxxxxxxzzxxzzzzzzxzzzzzzxzxxxxzx <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 /> recycling facility. The holder of the permit with number noted below is responsible for <br /> ensuring that this form is completed and returned <br /> FACILITY NAME: KRTS <br /> FACILITY ADDRESS: 9901 Woodward Road, Ripon <br /> TANK ID 139-_/5�3 <br /> *xxx******x*******xxx**x*******xxxxx**x***x*x******x******xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxz <br /> SECTION - 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 Zip: 95240 <br /> / Phone#: <br /> Telephone: ( 909 ) 368-6175 Date Tank Removed: ��le- <br /> x*it***z*z**x**********zz**z**xxzx****x**z***x**xxz**x**z*zzx*xx*zzxzxxxxxxxxzzxxzzzxzxxxzxx <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIM THORPE OIL, INC, / Nor-Cal Hauler of Rinsate <br /> Address: 807 E. Black Diamond, Lodi , CA 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 /> SICK 'TITLE <br /> ****xx****x**xz**x*x**x*x*x***xx***xxzxxx*xx*xx**xxx**xxzzzxzzxzzxxxxzzzzzzxxxzxzxzzxxzzxxz <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 /> .CHNITZER STEEL PRCD'JG1-; <br /> Address: 12000 FOLSOM BLVD. <br /> Zip: <br /> etasa�A;0 Phone#: <br /> Date Tank Received: - <br /> AUTHORIZED SIGNATURE AND TITLE <br /> x********xx********x*****xx**x*xxxx***x******xzxxxxxxxzxzzxxzxxxzzxxxxxxxzzzzzxxzzxxr.r.zzxxz <br /> EH 23 099 12188 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />