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PUBL�HE.ALTH SEE' TWES <br /> SAN JOAQUINCOUNTYe0a -4JOGI KHANNA M.D.,M.P.H. <br /> Health Officer • , <br /> P.O. Box 2009 • (1601 East IGzciton Avenue) • Stockton.California 95201 � tta <br /> (209) 468.3400 <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> SECT ION I - Public I lealth Services Tracking Sheet will accompany each lank affixed with its site Identification number. The <br /> Tracking Sheet is to be returned to Public I leaith Services within 30 days of acceptance of the lank by the disposal or recycling <br /> facility. The permit holder is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: Curtiss Pontiac Cadillac GMC Inc <br /> FACILITY ADDRESS: 2450 Toste Road Tracy CA <br /> TANK ID #39 - /f -77p0,? Tank Description: 1 - 1 000 gallon undergroundRog gas tank <br /> .......................•••••+.•.+•••••••••. .•••+•...• <br /> SFi7I'I0N 2 - To he filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. DBA RICH-MART CONSTR. <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi ,/CA Zip: 95241 -0357 <br /> Phone #: ( 209 ) 368-6175 Date Tank Removed: <br /> SECTION 3 - to be filled out Vy.contractor "decontaminating hnk": <br /> Tank Dcconlanlfnallon Contractor: JIM THORPE OIL, INC DBA RICH-MART CONSTR./Nor-Cal Oil , <br /> Hauler of rinsate <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized 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 Fleallh Services. 1 <br /> Signature: al/Z v�G"!ad%� S, Title: Vice-President 1 <br /> Tank is free of all sludges and hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> +r.•••••••+••••••••••••••••••••.•.••••.••••rr•••••••••r+u•..••••r++•+s..+•+• •••r•s••.r•••••.•••r...H...a <br /> SECTION 4 - To be signed and dated by an nuthorized representative of the treatment, storage, or disposal facility <br /> acce ling tank and/or piping. <br /> Faclifiy Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordova Zip: 95670 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> i <br /> Signature: Title: <br /> .......................•......•......................••.... <br /> ..,............••..........+•..........•....... <br /> Page 10 <br /> ER 23 069 (Rev 2/8/91) wp <br /> A Uidslnn of San Jnagwin Cmmry IInOh rvt.Scnitte �, <br />