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PUL , ., C HEALTH RtIVICES tai . r, <br /> cc `r <br /> 5AN JOAQUIN COUNIY =` <br /> c <br /> JOGI KIIANNA XI.D., bl, P.11. <br /> Ilnhh Officer <br /> � <br /> P,O, flux 2009 • ( 1601 East [WOlon Avenue ) • Stockton, Cslifornia 95201 dd'A <br /> ( 209 ) 469.3400 <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> • • . . • • • . • . • r • . t • . • • . . • • • r . r • • • • r • • a • • r • r • r . • • rrr • . rr • rr • • r • • • rrt • r • t • • , t , r • • , • rrr , , , , • , rr • rr • , r • , • r • • . • , • • <br /> SECIlON I - Public I leallh Services -Tracking Shect will accompany each lank affixed with Its site Identification number. The <br /> flicking Sheet Is to he returned to Public I leallh Services wilhht 30 days of acceptance of the lank by the disposal or recycling <br /> facility. The penal! holder Is responsible for ensuring dial [his form Is completed and returned. <br /> FACILITY NAME: Barnes Trucking <br /> FACII.. ITT ADDRESS: 1817 S . Fresno Ave . Stockton Ca 9 206 <br /> TANK ID #39 - 'Tank Dcscriplloo: <br /> 10 , 000 gal & diesel fuel <br /> • . . . . . • . . . . . . . . Otto • • • . • • • . . . . . . . . . . . . . . . . . . . . . • • . . EPA : : :e. b . .G.l. . . . . . .Q�. . .1: GY.�.�. . . . . . . • • . • . . . • . <br /> SFC170N 2 - To be filled out by lank removal contractor: <br /> 'Tank Removal Contractor : JIM THORPE OIL , INC . DBA RICH -MART CONSTR . <br /> Address: 351 N . Beckman Rd . , P . 0 . Box 357 City: Lodi , CA Zip: 95241 -0357 <br /> Picone # : ( 209 ) 368 - 6175 Dale Tank Removed: <br /> t • t . • rr . t • • • tr • • • r • • • • • • • . ♦ r • . rr • r • r . • rt • • • . • • r • • • r . , • • • • t „ • • • t • rrrrrr , • • • r „ • • • , • • • , • , • • r , , , , , , „ • „ • , rr • <br /> SECTION .3 - Io be filled out b'y contractor "decontaminating lank": <br /> Tank Decontamination Contractor: _ JIM THORPE OIL , INC . DBA RICH- MART CONSTR . /Nor - Cal Oil , <br /> llauler of rinsate <br /> Address: 351 N . Beckman Rd . , P . 0 . Box 357 City. Lodi , CA Zip: 95241 - 0357 <br /> Phone # : ( 209 ) 368 - 6175 <br /> Aulhorized representative of contractor certified by signing below that [he lank has been decontaminated In an approved <br /> manner as required by the Slate Department of Health Services, <br /> Signature: 12Zgf l�ttf 7 no Title: Vice - President <br /> • ' Tanktis • tree oof all � s,ludge sludges rocarbon Vapors upon delivery to Schnitzer Steel <br /> . . . . . . . . . tot • • t • • o • • • 9 # 0 • • . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. • . . . <br /> SECTION 4 - To be signed and (filed by an authorized representative of the 46atment, storage, or dAposal facility <br /> accepting lank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd , City: Rancho Cordova Zip: 95742 <br /> Phone # : ( 916 ) 985 - 4810 <br /> Date Tank Recelved : �f <br /> Signature: Thle: <br /> Page 10 <br /> Ea 23 0449 ( Rev 2/a/91 ) vp <br /> A nldilnn or San JntTdn enunty Ileahh Core ScMccn �) <br />