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PUBL�� HEAEfH SEX;ICES <br /> SAN JOAQUIN COUNTY <br /> J(x;I KIIANNA M.U.,Ai.P.11. • <br /> Ilcsllh <br /> P.O. box 21X19 • (IWI Fast floxchon Avml:c) a Stockton, 6111 rnla 93201 8� <br /> (209) 468-34mX1 <br /> t <br /> UNI1r�ItVROUNI) 'TANK DISPOSITION TINCKING RECORD <br /> 1111R••R4R•••••1I•••1••••••a••••••1•••••1••••••I•R•1•••••N•1••RIIR••HlRH•••a•R•••.•.•••R.••••••••••••..• <br /> St',(.:f1UN 1 - Pnlrife I leallll Services Track Ing Sheet will accompany each tank affixed wilh Its site ldentlficallon number. 1110 <br /> 'l larking Sheel Is In he teturned to Politic 1 Icallh Sctvlces w10111130 drays of acceptance of the lank by the dlspwal or tccyding <br /> facility. 'Ilse perinll holder Is reslronsible for ensuring that this form Is compleled and returned. <br /> FACILITY NAME: Sears Roebuck & Co. EPA # <br /> FACILITY ADDHESS: 5110 Pacific Ave. Stockton CA 95207 <br /> Product <br /> 'LANK Ill #39 - 'Tank Description: Lines Gallon (gasoline) (diesel) (waste oil) <br /> •1•••►•►!••••i•••••••••••••r••R••••R•R••••••RR•R•••11•••••R•►••R•••1R••••••a••••••aa•••ss.••••••.••a•••••• <br /> Sl.(:l I1.1N 2 - •1'o IIe filled out by lank removal cantlactor: <br /> •I rank Removal Contraclor: JIM 1110RPE OIL, INC. DBA R I CI I-MARC CONST R. <br /> Addiem: 351 N. Beckman Rd. , 11. 0. [lox 357 City: Lodi , CA Zip: 95241-•0357 <br /> panne : ( 209 ) 368-6175 Date"Tank Removed: <br /> i <br /> ••••••1/•1••I••111►11R•1••1••••••••1•••••f•R•IR•1•R•••••••••RRR1••a••••••••••••••a•••••!a••••••••aa••!I•a•a <br /> SI:(:f ION .1 - to lie filled olll by contractor "decontanlinntlllg tank": <br /> 'Tank Decontamination Contractor: JIM TIIORPE OIL, INC. ODA RICI1-MART GONSTR. Nor-Cal Oil <br /> au er o - r rasa to <br /> Addtrss: 351 N. Beckmalt Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone 209 368--6175 <br /> Alrlhorlred representative of contraclor ccrllfied by Signing belllW that the tank has been decontaminated In an approved <br /> manner as requited by the State Department of f lealth Services. <br /> Sigllnture: 'ITIIe: . <br /> of <br /> •• 11 •• •1,•• •1 •!• •r�••••••1• f•1•s!•f• •1R•4••••�••••••R•• • •11••••*•U••�•�••.•R•••!!•I• •••••••• <br /> fang -51 tree oY all sl`tt(lges and•1lydrocarborl vapors uron crVivery t c adStier 5tei�� <br /> St,:0I00 4 - 1'o he signed and Baled by an r!(Ithorized represel tsltlre of the treatment, storage, or sposal fac 1 y <br /> nccepting lank and/or piping. <br /> rnElllly Maine: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. city: Rancho Cord7-lp: 95742 <br /> rhone N: ( 916 ) 985-4810 <br /> Dale 'Iauk Itecelved. <br /> SIgnatule: 'Title: <br /> •••••••••••••••••••••••1••••••••R•R•R•!lRRI.1•I•Ia••••RRRIR•RII•••1••R•••f••••R•aa••••••••••11••��•••••�•• <br /> rage 10 <br /> 1" 23 049 (Rev 218191) up f <br /> J{blvl%rnq d San tnaTtln fnunrr I le Rltlr C•te Scnicta <br /> \� <br />