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r <br /> UNDERGROUNII STORAGE TANK DISPOSITION TItACK1N0 RECORD <br /> rl►►#!►►#•►►►►►►l►►460004449♦44#000040#040#♦•0►►#4#00004404000►0600►►#••#i###►#►►►►#4#H##►►►►►►►###►#►##### <br /> UiCCION I - Public Ilealth Services Tracking Sheet will accompany each lank affixed with Its site identification number. <br /> The Ttacking Sheet is to be relunted to Public Health Services 1Y11llirl 311_ dills of acceptance of Ilse lank by the disposal or <br /> recycling facility. The permit holder Is responsible for ensuring that this form Is completed and returned. } <br /> FACILITY NAME: Van Ile Poi Enterprises <br /> Z <br /> I:ACilwWY ADDRESS-024- Pacific Ave Stockton CA 95204 <br /> TANK iD #39 - Z Tank Descriplion: 10,000 gallon <br /> 11#►►►/+sills#s#!s►!!►!#s!!►##rrrs!!1►l►11#►►►►#ss•#!####►!►###s#s#s####s#s#•#!#!♦►#►#!l►►s►s###•►!!s#1###! <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> Tanis Removal Contractor:JIM THORPE OIL, INC. <br /> Address:. 951 N. BECKMAN RD. / P.O. BOX 357 _._ City: LODI, Zip: 95241-0357 <br /> Plsone #: (209 ) 368-6175 Dale 'rank Removed: �9 <br /> •«►r►rrrrl##•4#►•##•••r►•#4##►►rr►4#►•►►►4►►•#►►•rrr•r4►•#•►##••#•►►•►####•#««44•#•«•«•►•►rr###►►#•••«####• <br /> 811,(-['ION 3 - To be filled out by contractor 'decontaminating tank": <br /> Tank Decontaminallon Contractor: JIM TIIOHPE 016, INC. _ <br /> Address: P:O. BOX 357 _ Clty:, LOW. _ ZIP: 95241-057 _ <br /> Plsone #: (209 .-}^ 368-6175 <br /> Aulho[Izcd represenlallve of contractor certifying through signature below that the lank has been decontaminated In all <br /> approved manner as requi ed by Cal "PA. <br /> Signature: Title: ;IIIire- PHI?SIDEff <br /> rs •• s# # ###f •#► #►►#►# •lar r►a► q►### #«►«rrr4►•!#r}•r#►rrr#►►►►►#•►#►##►►►#►►!•!!►##1#►•►►#•#►►!• <br /> 51 C <br /> SECTION 4 - 10 a Igned and ted�y all ntitito zet rej sra ve oVtli a iYsp�i�al � � xer Steel . <br /> accepting tank and/or piping. <br /> Facility Name: Schn1 tzer .Steel Products <br /> Address: 12000 Folsom Blvd. city: Rancho Cordova_ Zip: 95742 <br /> Phone #: 9( 1 985-4810 <br /> Date Tank Recelyed: <br /> Signature. � /LCx Title: <br /> !!•!♦r•Ir#s#!#►►►♦###•rsr#ss#�r•••#•##««••rr r•►r•r#s#s######r#r•4rrr««4►#4►#►s#►►rrs#s##sr##!4##►•rr#• <br /> IN 23 049 (Revised 7.10-92) Page 10 <br />