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SWTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with Its site identification number. The Tracking Sheet Is to be returned to San <br />Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br />,lecyclin` facility. The b2ldgg • ' !i° 2gi witb nUWXX 02to •,:. .X is r22R=ij2jC f2X <br />Wagging that this f2Ka in gomplefj1d Do rn=Wd. <br />M: JIM THORPE 1 • <br />rli r►' Be • •' •�Lodi,• 1 r <br />_ PRO <br />• <br />1200 <br />TAW ID139- 1310 1_ RANC,40 <br />ncriON <br />Removal Contractor: JIM THORPE OIL, INC. <br />teas: 351 N, Beckman Road, Lodi, CA Zip: 95240 <br />firD <br />p 8: (2 462-4581 <br />_---i PRODUCTS j RC® <br />Telephone: mo. s <br />Co <br />ION 3 -To be filled out by contractor 10decon i:natinq tank": -91G_,,8,,4,, <br />�® <br />�0�E® <br />T** Decontamination" Contractor: JIM THORPE OIL, INC./ Nor -Cal Hauler of Rinsate <br />807 E. Black Diamond, Lodi, CA Zip; 95240 <br />C;:iid;TZE,A STEEL Panni ir, <br />Authorized representative of <br />decontaminated in an approved <br />• '*igning below •r,. • . <br />?,Uted by Department <br />SWrICK. be filled out and signed • . r • represnetative of the treatment,, <br />storage,, or disposal facility accepting tank. <br />STEEL <br />. <br />•r•> <br />rr/ i • r... <br />A 05 Zip: <br />916-985-4810` • ' s <br />Date Tank Received:A <br />RN 23 049 12/88 <br />MAILING INS ICN3: <br />r <br />ALMORIZED SIGNATURE AND TITLE <br />FCLD IN HALF AND STAPLE. AWIX PROPER POSTA(Z. <br />SAN JOAWIN LOCALi DINRICT <br />r:a• �- • rTANK PROGRAM <br />P. r Box 2009 <br />STOCKTONr M 95202 <br />