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$2+aN .7CDT " LJIIV LOCAL E MAT rr - DISMI CT <br /> UNDERG (X)ND TANK DISPOSITION TRACKING RECORD <br /> !ltti!!R*tltttRlk*ttR***RR*k**RRktkt*tR*R**t Rfi tt*RtR*R*RRtRRfItRRtRtkkiR*tkRittittlttittttRt <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> affixed with Its site identification number. The Tracking Sheet Is to be returned to San <br /> Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. The holder of the oeznilt with nt>mhe3 Voted below is resooaslble for <br /> enuring that thio form 15 compiP*ed and returned, <br /> FACILITY NAME: Charles E. Skobrak <br /> Stockton, CA 95202 <br /> FACILITY ADDRESS: <br /> OOd <br /> TANK ID 139- /�v�� - �— 1 -'5f)& gallon gas tank EPA Site #CAC 000272441 <br /> t*R*tt*RtR*t*t**t*RR****tRt***RR*kttRRkttRtR*fiRtRkt*RR**ttkttRlRtR*ttttRtRt*ttRRt**RtkR*tit <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 351 N. Beckman Road, Lodi , CA 95240 <br /> Zip: <br /> • �/ ,/Phone$: (2 3� 68-6175 <br /> Telephone: ( 1 Date Tank Removed: <br /> **ltttRRkttkfik*kkk**Rt*t*Rttttttt****t*kkt***Rtt*tt**RRkRRtRR*ttRttRRttRttRtRR!*ttRRRtRt*tR <br /> SWTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> Address: 351 N. Beckman Road , Lodi , CA Zip: 95240 <br /> Phone$: (209 368-6175 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> Z_ Vice-President <br /> SICNA 'AND TITLE <br /> *****fitRkkRt**k*fitktk*k*k*t******tit*RfitkR*****R*tit***kRR**k*R***t**kkRk*k**ttttklkR***tRt <br /> SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd Rancho Cordova CA 95742 Zip: <br /> Phone$: (916) 985-4810 <br /> Date Tank Received: <br /> A IZED _SIdNAnM PND TITLE <br /> ***tttttR**kRttt***t***Rt****tttti*RkR*Rtt**kR*tit *RR*RRtt*R*t***R*t****tt****t***tt**t** <br /> CH 23 0$9 12188 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. O. BOX 2009 <br /> STOOCTON, CA 95202 <br />