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PURLIC HEALTH SER <br /> CES <br /> t <br /> SAN JOAQUIN COUNTY <br /> . JOGI KHANNA M D.M P H ' <br /> Health 4flicet � <br /> E p Box 2009 • (1601 Eut tiszciton Avenue) • Stocki Callforrtia 95201 <br /> (209)46&3400 <br /> UNDERGROUND TANK DISPOSITION 1RACKING RECORD <br /> •.04N$sNN*N�srs*sr0r**000000*NN04*40000*0*000000000*060*0*N0400N*040000400000$40*N004N0aNNNN* <br /> its site <br /> dentification <br /> er <br /> SECTION 1 - Public Health Services Tracking Sheet viiees wlilmp��da x of acceptantank ce o(Ithe tanklby the disposal or becyc111 g <br /> Tracking Sheet is to be returned to Public Health <br /> facitity The permit holder is responsible for ensuring that this form is completed and returned <br /> FACILITY NAME Mildred De Vi-----' <br /> FACILITY ADDRESS 21167 Tretheway Rd Acampq,Cal <br /> TANK 1D #39 - <br /> Tank Description 550 gal regular gasoline <br /> N$ssNssNSN$NasrssssNNsssssssssNssssssNNsss$*sr$srsrsss*ssrsrrsssssssNrNNsssNSNsr*rs:sssNsO <br /> SECTION 2 - To be failed out by tank removal contractor <br /> Tank Removal Contractor: <br /> Address- <br /> City ZIP.c� — <br /> Address- <br /> one # Date Tank Removed <br /> .$res$NsssessNNNSNsrssrsrNsssrssNSN*N*s*rs*sss***0assess.s0asr4NrN*rsss$ssssNssrssNNNssNs <br /> SECTION 3 - to be filled out by contractor •decontaminating tank':c. DBA Ric — art Const uction <br /> Tank Decontamination Contractor Jim e 0 <br /> Address Po bx 3 1 N. Beckman Rd. City Lodi ZIP 95241-035 <br /> Phone #. (20 368-61 5 <br /> Authorized representative of contractor certified by signing <br /> Services w that the tank has been decontaminated in an approved <br /> manner as required by the State Department of <br /> HealthTitle- <br /> Signature- , <br /> sr*rNrss.rsssNsssssssNSNrsssNsss*sOSNSNsrNsr0rsN0s**r*s*sssssssssOsssNOssssas00ssNNssNssssssss <br /> dated b Iran authorized representative of the treatment, storage, or disposal facility <br /> SECTION 4 - To be signed and <br /> accepting tank andlor pipinn <br /> Facility Name: Schnitzer Steel <br /> City Rancho CordovaZip 95742 <br /> Address 12,000 Folsom Blvd. <br /> Phone #. { 91� 9 35-4810 <br /> Date Tank Received <br /> Title: <br /> nature* <br /> s*N*srr400000+srs*sss$..ass*NeNSN*Nsssr*$NNP*pe 10$*ss*r4rs$*040404$040*$*4*re's*$srN*NNrr4sNrr <br /> C <br /> EN 23 049 (Ray 2/8/91) WP <br /> A Dlrlslan at Sin 1oa4°h County tlrAth fue 3ervtces <br />