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. S.i1lV J�S]UI1V LOC.,,AL, I-IF'n�-� D2 STF2I CZ' <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <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 b disposal <br /> recycling facility. Y poral or <br /> The holder of the permit with number nnhaa elow $ /zQ Rb6&i aA Ftb <br /> EDsurina that thio fnrm fa rn 1 t� <br /> FACILITY NAME: KRTS <br /> FACILITY ADDRESS 9901VRWOodwat dll Road, "Ri pon <br /> TANK*,°*xxx /� <br /> 2-- <br /> �t . <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor:' ° `'"IHORPE OIL, INt'. (:• ::I.cTi liiili.l. <br /> _ ..._... _ - --...... ....... Z1p - <br /> Address: 351 N. Beckman Road, Lodi, CA 95240 <br /> _.....__...__..._._..._.. ..__.._.....__...._._.._...... _...-...._........ <br /> _ <br /> Phoned;'._.._.._._.__._.._._..... <br /> Telephone: _ ( ?(l lc r)_.358,fi1.1.5 Date.-Tank-Removed: +0� ' � _ _. __...__........... . ... <br /> _..... <br /> xxixxxxxxxxxxxixxxxxxxxxxxxxxxxxxxx3x3xxxxxxxxxxxxxxxxxxxxxxxxxx*xxx**xxxxxxxixxxxxxxxxxxxx <br /> SECTION 3 -TQ._be .filled._out. by,.contractor- "decontaminating-tank";_.._. ___...__......_......... <br /> Tank Decontamination" Contractor: JIM THORP OI.Lr, INC. / ,Mgr-Cad Hauler. <br /> Address: 807 E. Black Diamond, Lodi , CA 95240 <br /> Zip: <br /> ......................__....._.....__. .._....,.._.._........_...__.._-................_...__...__..._...._..._..----PlioiieU_._M9 -... _ 75 <br /> Authorized _representativeof--contractor- certifies by signing_be10 -.been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> J�0,� (}} r&db _I '.1i11. nitafi=kl <br /> SIC�IA ANWITLE <br /> xi xix**3****33**xixix*3x3*33*****xxi***ix*x*xixx`.+*�."�.xYrxiert*xxxxlntxixxix7exwx3-3�xxiFxxt!tik,�jrllr�{y�xxx <br /> SECTION 9 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank, <br /> Facility Name <br /> 1tdUClki <br /> Address: SCHNITZER STEEL PRODUCTS CO. Z14. <br /> ae •awn-mannva_.CA...-a�"id3.........._..._........._...._,.............._..-._. Firj - <br /> 816985�810 Phor►eA.-.•':, <br /> DateTank Received: _...__.. .. ..... .. ........_-__._.._.___.__.._____..-_....-....._.......-..__...._ <br /> ---'-----....._.._.__LjfdP'IL! A.1.dr3dllelc''t1W. <br /> _ .... ....... - ------ _ <br /> LMIORxxEDxxx�x�xx�xxxxTEZx**xxxxxxxxxxxxxxxxxxxxxxxx*xxx <br /> EH 13 019 12188 <br /> HAILING INSTRUCfION3: :::;i k <br /> FOLD IN HALF AND STAPLE, AFFIX PROPER POSTAGE. <br /> SAN JOA(1UIN:.,EPgAlr, HEALTH 'DIS'IR-ICT <br /> ATTN: UNDLIj(R%W TANK PROGRAM <br /> P. O. BOX 2009 ;, l <br /> STOCKTON CA15202 ;;. <br />