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ES .. .... <br /> PURL HEALTH is <br /> SAN JOAQUIN COUNIY �: 1 <br /> Joc;1 KIIANNA NID,AI.I'.I1. <br /> licalrh Ulfitcr ��lli��5'gr': <br /> P.(). lk?x 1(x19 * (1fro1 East linchnn Avenue) • Slocklon,California 95201 <br /> (209)468-3400 <br /> UNl)r:lt(;ROUND TANK DiSI'()S1'1.1()N TRACKING RECURI) <br /> •••rrr <br /> 410 <br /> ••r••!•rrrrrr•rrrr•rr+••••+ •rrrr•r•r••••rrrr••••rrr+rr+rrr•r••r►rrrwitilrllssite I(IEllllfiCA110nrrrURlber*rThe <br /> SRCI 1()N I Public l lea11h Services '1'rackir+g Slice[ will accornpatty each tank Affixed <br /> of the lan <br /> 'Ice <br /> fcking'Slice, is (n <br /> be returned 10 Public I leallit Services wlthilr 30ys of accepid and t turnedk by the disposal or recycling <br /> facility. 11+e pennll holder is responsible felt er+sating that this form is comp etc <br /> Frederick R. Mayers <br /> FAC;i1..1FY NAME: <br /> 126 S. Main St Lodi, Ca. 952+0 <br /> FAC il..l-1-Y ADDRCSS: Gasoline <br /> 500 gal. Unleaded Reg <br /> "TANK 11.) #39 bank Ucscription: <br /> .••.••••r•••••••••••••••►r.•r••.••rr•rEPA�SiFe*� rr � ir•rrrrrrrr !rrllrr:rrrrrrrrr <br /> Sr.("11()N Z lt� ne tined tuft by t JtIM THORPEoOIL,removal oINC. DBA RICII--MART CONSTR. <br /> 'i rink Removal CUnlractUr: ` Lod i , CA Zi :: 95241-0357 <br /> Address: 351 N. Beckn+an Rd. <br /> P. 0. Box 3�7 City: p <br /> P}+Ane #: (_ 209 } <br /> 368-6175 Dale 'Tank Removed: <br /> +�.�••••.,•••rr•r•r•rr•r••r'r•'rr*rr•t•r••,•rrrrr••rr++•r"rrr•r•!••rlrrr•rrrlr•!•rrrrlr!!!!�rlraaral:!lrara <br /> Sril <br /> Cl'ION .� <br /> to be filled out b'y contractor "tlecontaminating tarok . Marler Df r nsate <br /> cnntanrination Grrrtractor: JIM TIIORPE OIL INC. DQA RICK-MART CUNSTR. NDr-Cal 0 <br /> 'I',ink Ue 95241-0357 <br /> -------- <br /> Address: <br /> 351 N. Beckn+an Rd. , P. 0. Box 357 City: <br /> Lodi , CA Zip: <br /> 209 } 368-6175 <br /> ed resentative of contrac(or certified by signing below that the lank has been decontaminated In an approved <br /> /lutbnrlr, rt p <br /> manner as required by the Stale Department of ileal(h Services. ViCe-president <br /> Title: <br /> Sigrtatttre: <br /> vapors upon delivery to Schnitzer Steel . <br /> ,,,,,,rrr•••rrr•e•rr••••r•••r•••r.•••r••••rr•••••••r••re•rrr"••lhe treatment,*storage, or disposal facility rrlrr! <br /> Tank is free of all sludges and hydrocarbon <br /> SRL i 1vN 4 - To he signed and dated by an null+nrlxed represtnlsrlive o[ <br /> Accepting lank and/or piping. <br /> raclllty Nartte: Schnitzer Steel Products � Zi 95742 <br /> Address: <br /> 12000 Fol son+ Blvd. City: Rancho Cord v n� <br /> PhunE : ( 916) 985-4810 <br /> Date Tank Received: <br /> Title: <br /> Signature: <br /> r,,,,,r,r•!r••••r••+��••••••••'r•••••rr•+r••rr•rrlrrrrrrrrrrr•rl+;•rr•rrr•rrrr•++�!•rlarrr•!rlrlrrrrllrr+• <br /> Page 10 <br /> fH Z] pG4 (Rev 2/a/91) up 1 ) <br /> A r)Ivrsfvn of Stn Jaiq+ifn[;nun+r neahfi t:rrc k,vlcea `/ <br />