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PUB&C�HEALTH SEr S ES tQ FA� <br /> SAN JOAQUIN COUNTY ` <br /> JOGI KIIANNA MD.,M.P.H. <br /> Ncalth Oili(et <br /> �FiP8t1r' <br /> P.O. Dox 2019 • (I60t East llazclton Avenue) • Stockton,Callfomia 95201 <br /> (209) 4683400 <br /> UNULRGROUND TANK DISPOSITION TRACKING RECORD <br /> •••..•••••••••••••••••••.••••••••••.•••••••••••••r.r•H••••••••••••/•r•ur/l/r•••rt!•rf H•f#If•Hf•♦f•Hfrf <br /> any <br /> tank affixed with its site <br /> SF,Cking SI'ec1 Isle rchc rehrtnc I to Public c I Ices alth Scrviees will in JO dura of a ceptance of the tank Ihenllisposal or recycling <br /> faclllty. Tile permit holder Is responsible for ensuring that this form is completed and returned. <br /> FACILITY NAME: Curtiss Pontiac, Cadillac GMC In <br /> FACILITY ADDRESS: 2450 To to Road, Tracy, CA <br /> TANK ID #39 - /,?77— Tank Description: 1 - 1 ,000 gallon underground unleaded gas tank <br /> .,..,.••....................•......................�PA.�i:,�.�.FAG.9DA�142h4.......................... <br /> SrCfIOfJ 2 - To be filled mit by tank <br /> J[Mr TIlov IIORPEo01L "714C. DBA RICH-MART CONSTR. <br /> Innk Removal Conlractor. <br /> I <br /> Lodi , CA Zip: 95241 -0351 <br /> Address: 351 N. Beckman Rd. , P. 0. Box 351 City: <br /> Phone a4: ( 209 ) 368-6175 Date Tank Removed: ? l bal — <br /> •,•••••.•,••••••••..••••••••••••.••••••••••••••••••••••••r••••�•!!•!•!rt!•tlf tl f111ft1l1lffftl tf•11!•1••!•• <br /> SECITON 1 - to be tilled out �y contractor "decontaminating tank": <br /> lank UcamlantlnaUon Contractor: THORPE OIL, INC. DBA RICH-MART CONSTR• Haulertofirtnsate <br /> 351 N. Beckman Rd. , P. 0. Box 357 City; Lodi , CA_ Zip: 95241-0351 <br /> Address: <br /> Phone d: ( 209 ) 368-6175 <br /> Aulhnrf¢cd representative or contractor certified by signing below that the lank has been decontaminated in an approved <br /> manner as required by the State Department of Ilealth Services. <br /> Title: Vice-president <br /> Signature: <br /> Tank is free of all sludges and hydrocarbon vapors upon delivery to Schnitzer Stee] <br /> ..•.......•.free .f all.slua ............................••......•........ .....•................ :.f•.. <br /> SECT ION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting lank and/or piping. <br /> Fncllity Name: Schnitzer Steel Products <br /> Address: <br /> 12000 Folsom Blvd. City; Rancho Cordova Zip: 95670 <br /> Phone (y: ( 916 ) 985-4810 <br /> t)atc Tank Reccfvcd: <br /> Titre: <br /> signature: <br /> ..........••,..............•.,...................••.......•.•.•••.••••.••.••••••..•r•••.•••••••••.••••!•••. <br /> Page 10 <br /> EN 23 019 (Rev 2/8/91) wP <br /> A Uhi,inn of Son Jmmdn Cnvnrr IIUhh Urs krvlcte <br />