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SES CESPUBL HEAKTH � ~ G <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D.,M.P.H. <br /> Ilealth Offi(er <br /> P.O. Dox 2009 • {1601 East iiaaclton Avrnue) * Stockton,California 95201 <br /> (209) 468.3400 <br /> UNDERCROUNI) TANK DIS110SITION 'TRACKING RElion CORD <br /> •.rarrraaa►►rrrraaa►rr«►«♦rr�rrrrrlr«a!al►►►««►►►«►!►«►r►rt!♦tr«►►l►►!!!«.!•►!!!►««.r►►l►►.««!«•!!►rrr««rr► <br /> entifi <br /> SECTION I Public I lenith Services Tricking Sheet will accompany each tank nk offixetan a with <br /> th it t site id the disposal or number. <br /> ecycling <br /> Tca <br /> ricking Sheet is to he returned to Public I leallh Services within 30 do-Y o P <br /> facility. 1-he permit holder is responsible for ensuring that this form is completed and returned. <br /> F'ACILIT'Y NAME: Boettcher Western Pro erties 1 Ltd <br /> 4555 N. Pershing Ave. Stockton, Calif. <br /> FAC11,11'Y ADDRESS: <br /> TANK ID #39 - 1 � '� r OZ-Tank Description: 12,000 gal. Diesel <br /> EPA Site # CAC«qp!►��`�0 3 !4►i ,n«r«►«►r«lr►r►«rrlr►r <br /> ,rrrrrarraa►►!•«.rail►a►r•rrr►r1«arrralr««!«•►•►/««►r«►f•►«!!!►«►►« r!!«!!! <br /> STCT1r7N 2 - To he filled out by tank removal Rcontractor: <br /> INC. DBA RIGH-MART CONSTR. <br /> Tank Removal Contractor* <br /> Lodi , CA Zi 95241-0357 <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: P' <br /> Phone #: ( 209 ) 368-6175 Date'l'ank Removed: <br /> .i.arrarraarr«r►►►����►«ra«r!lrarr!!rr►ara►l►►««!!«!►r«N r.le►s.sls.ff!!!!!►!!►•►.r4!!rf!!.►r.•*r!!.#►l.►.r <br /> SF(;1'10N 1 - to be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. DBA RICH-MART CNSTR• Hauler lofirinsate <br /> Address: <br /> 351 N. Beckman Rd. , P. 0. Box 357 City; Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authnrized representative of contractor certified by signing below that the tank has been decontaminated in an approved <br /> manner as required by the State Department of F-lealth Services. <br /> Title: Vice-President <br /> Signature: <br /> Tank is free of all sludges and hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> aaa.rraa«r♦►rra►rrrarar!►rral►aaa►rarrrrrrr!►«►««rr►l►lee►l►«r•►«►►!!««s!►!r« •«!rr!►l►rrrrrr►«►r«!« !►r«r <br /> SECTION 4 - To he signed and (filed by an nuthorized representnilve of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordov Zip: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Title: <br /> Slgnaturc: <br /> ...................................r..........rrr«ar«!lrrr►«r««««a««r««►««««.«....«.....«...««r!««r««««r►«o <br /> Page 10 <br /> fH 23 049 (Rev 2/8/91) ++p <br /> A 0M.Ann or Sin jnimrin county flt21ih Csr[Serleet � <br /> 4 <br />