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PUBLI�AHEALTH SERAIJ,ES <br /> 5hNJ0AQUINCOUNTY �: < <br /> J(X,I KIIANNA AID.,MY 11. <br /> i1calthOlfi(et • r�li ��:� <br /> P.O. 0nx 20X19 • (I(,Ot East lbi ellon Avenue) •Stockton,cAlfomis 95201 <br /> (209) 4G&3400 <br /> UNDER(;ROUND TANK DISPOSITION TRACKING RECORD <br /> •••••••.•.••.•.•••...•..••••r••.•••...r••r••••••••r•••••r•r••••r•rr•f••u!•f!f••••!ff lff f•!•!f lff!•!!flf of <br /> SFCfION I - Public I Ieallh Services Tracking Slice, will accompany tach tank affixed with its site Identification number. The <br /> Tracking Shee1 Is Io he rennrned In Public I Ieallh Services within 39 days of acceptance of the tank by the disposal or recycling <br /> facility. I he permit holder Is responsible for ensuring that this form Is completed and returned. <br /> FACILIIY NAME: Curtiss Pontiac, Cadillac GMC I <br /> FACII_11Y ADDRESS: 2450 Toste Road, Tracy, CA <br /> 1 A14 ID #39 - /S' -77— OA Tank Description: I - 1 ,000 gal . underground unl eaded prem. gas tank <br /> ............................•.................../..Wt1ML%.1.F/1 MAU4 M04,flfffffff/ffff.fffffffff <br /> SF('fION 2 - To be filled out by lank rmovalTHOREo OIL,o[NC. DBA RICH-MART CONSTR. <br /> lank Rcnlovni Contractor: JIM <br /> Address: 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241 -0357 <br /> Phone N: ( 209 ) 368-6175 Dale-Tank Removed: <br /> 11•.r1.•r••1.•.•.•r1.••••.••1••.•r••••••••••••r••1•Ir1••!!fflrrlf!lrff r!!••fffffrf♦!f lllf!!f llfff!lf/flfff• <br /> SFCfION 3 - to be filled not ¢'y contractor "decontaminating lank": <br /> 'lank Dccontamfnilloll Conrracmc JIM THORPE OIL, INC DBA RICH-MART CONSTR•/Haulerlofirinsate <br /> Address: <br /> 351 N. Beckman Rd. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone >y: ( 209 ) 368-6175 <br /> Autbntl7ed representative or contractor certified by signing below that the lank has been decontaminated In an approved <br /> manner as required by the State`Dep�laJ/'rtment of 1leallh Services. <br /> SIQna1111C: I ({�/_ �• ��fc�+- �0 Title: Vice-President <br /> Tank is free of all sludges and hydrocarbon Vapors upon deliveriy to Schnitzer Steel <br /> .....•...........................•....•...................•.................. ..........f........... :...l. <br /> SFCIIUN 4 - To he signed and dared by an nulhorixed representative of the treatment, storage, or disposal facility <br /> act: ling lank and/or piping. <br /> Facithy Name: Schnitzer Steel Products <br /> Address•. 12000 Folsom Blvd. Cify: Rancho Cordova Zip: 95670 <br /> Thone d': ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Signature: Title: - <br /> ..............................`.................•....•.......••.•••....•••••••••.•••••••r••.••••••••••••.•. <br /> Page In <br /> En 25 00 (Rev 2/9/91) WP 1 <br /> A D100on of SIR INTO Courcy llcAlih Urc Scnicca C/ <br />