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iloj%r-�r DlszRlcr <br /> $Aii ,70T'-"JIN LOC.�L <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> tflffRRtfRRttttRRf tRtf*Rtt**R***R*R**RRtRR**tRRR*RRR**tRR*RR**t*RRtf R****R***tR**** f tank 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each <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 <br /> ntah2T notes btank <br /> is disposal <br /> albor for <br /> recycling facility. The_hald.Pr or the <br /> ensuring that this form la completed and returned. <br /> FACILITY NAME: Charles E. Skobrak <br /> C)&_ -72.• Stockton, CA 95202 <br /> FACILITY ADDRESS: o00 <br /> TANK ID 139- //�� - 1 - gallon gas tank EPA Site #CAC 000272441 <br /> *RR*RRRR*R*tR*R*t*tR*RR*R**R**kRRRRRtR*R*kR*R*RR*kRR*tR*kRRkkRR*RR**R*fR***RRRRf R***RR*RtRf <br /> 9WrION - 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 /> Phone—S: (2 3Q9 6�5 <br /> Telephone: ( ) Date Tank Removed: <br /> ***RRRRR*RRR**RR**R*RR**R*R**RRRR*R*RRRRt*R*R**tR*RRRtR*RR**R*R*k**R********k*R*t**tRtRtf RR <br /> SE)CI'ION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: JIM THORPE OIL, INC. / Nor-Cal Oil , Hauler of rinsate <br /> 351 N. Beckman Road , Lodi , CA Zip: 95240 <br /> Address: <br /> Phone#: 1209 368-6175 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated In an approved manner as y be regulated by Department of Health Services. <br /> Vice-President <br /> SIGNATURE AND TITLE <br /> RRkk*RRk*RR**tRR*tRkRRktRRR*k**R*R*RR****kR*RR****kR*k*R*R*RRRkRR****R*ttRRtR**R*R***R*kRRt <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 /> V km <br /> A IZ SIGNA AND TITLE <br /> R*Rt***fRRRtRRRRtkR**tRf RR**t**Rt*RR*k****RR*R RR*kRRR***RR***RRRtRfRt*Rk***kk**Rf t*Rf**fR <br /> CH 23 049 12/88 <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. DOX 2009 <br /> STOCKTON, CA 95202 <br />