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PU ► . � C HEALTH SEI . VICES ,g�4 ;�U11 SANJOAQUINCOUNIYJ(X,I KIIANNA FLU. h1. P. 11P.O. Itox 2(1(19 • ( 1601 Fast llazcllon Avenue ) • Slockton, ""torula95201 ( 209 ) 46&3400 UNDERGROUND TANK DISPOSITION TRACKING ACCORD • . • • • • • • • . • r • r • • • • • • • • . r • • rrr • • r • • r • . • • • • rrr • rr • • r • rr • r • rrrrr • rrrrrr r • r • • r • • • rr • r rr r • • r • • r • • • • • • • • • u • • r rrr SECI ION I - Public I Ira llh Services Tracking Sheet will accompany each lank affixed wlth Its site Idenllficaflon number. The J rackhtg Sheet Is to be returned to Public I Ieallh Services within 30 days of acceptance of the lank by file disposal or recycling facillly. the pennlf holder Is responsible for ensuring that [ his form Is completed and returned. FACHA I Y NAME : Barnes Trucking FACIL.lIT ADDRESS : 1817 S . Fresno Ave . Stockton Cat 95206 'TANK IU # 39 - 5 6 o 10 , 000 gal . diesel fuel �- 'tank Description : • • . • • • . • . • • • r • • . . • . . r • . . • . • • • . . . . • . • . . • • . • . • . . . r • • . EP/1 � : te. r .L.i• . . . , , ,Y. Y . . .`� . IY.:• . • • • . . • • . • . • • • . SECTION 2 - To be filled roll by look removal contractor: 'funk Removal Contractor: JIM THORPE OIL , INC . DBA RICH - MART CONSTR . Address: 351 N . Beckman Rd . , P . 0 . Box 357 City; Lodi , CA Zip; 95241 - 0357 Phone # : ( 209 ) 368 - 6175 Dale Tank Removed: • rr • rrrr • • • rrrr rrrrrr . • • • • • r r . r rrr • r • rrrr • r • r • rr • r • • „ r • r • rr • r . r • rrrrrrrr • • • •a • r • u • • • • • • • • u • • • • • , • • • , • n • SECfION .3 - to be filled out b'y contractor "decontaminating lank": 'lank Decontamination Contractor. JIM THORPE OIL INC . DDA RICH - MART CONSTR . Nor - Cal 011 hauler of r " sate Address : 351 N . Beckman Rd . , P . 0 . Box 357 City. Lodi , CA Zip; 95241 - 0357 Phone # : ( 209 ) 368 - 6175 Aulhorized representative of contractor certified by signing below that the lank has been deconlaminated In an approved manner as required by the Slate Department of health Services. Signnlune: _ � w2o� Title: Vice - President Tank is free of all sludges andl(yrocarhon vapors upon deliverjy to Schnitzer Stee � r • • • • • • • • • • • • • r • . • . • • • r . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • r r • • • • • • • • • • • • • • . r • • • • r • • r • • • , • • • • • • • , i • • . • • SECTION 4 - 'Po be signed and (filed by an nuthorized representative of the treatment, storage, or disposal facility accepting lank and/or piping. Facility Name: Schnitzer Steel Products Address : 12000 Folsom Blvd . City: Rancho Cordova Zip: 95742 Phone # : ( 916 ) 985 - 4810 Dale Tank Recelved : Signature: Title: , • . • • . . r • • • • . • • • r • • • r • • • rrr • • • • • . • • • • • • • • . • • . • r • • • • • • • r • r • • r • r • • rr , • r • rr • • rrrrrr • • r • r • r • r • r • • • • r r • • • rrn r • Page 10 tm 23 069 ( Rev 2/0/911 up A 014.0nn or San )mgnln Cnomr IInIJI Care Scndeea �)