Laserfiche WebLink
SAN JOAYUIN COWrV PUBLIC HEALTH SERVItLS <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND S'T'ORAGE TANK DISPOSITION TRACKING RECORD <br />a••+aaa+aa}4+snarl++raa+la++!#+r+♦ri#+♦+r}r+r+#Pira+a+♦r##r#♦rlr+lrl#!ia►+4i►f►►►►►+►►44►H4►ff444f►ffNfff <br />SEC I ION 1 - Public Ilealth Services Environmental health Division Tank Tracking Sheet shall accompany each Wilt afRaed <br />will, its site identification number. the Tank Tracking Sheet is to be returned to Public health Services Environmental Health <br />Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder Is responsible for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: <br />rACR,i'IY ADDR <br />Henry Hansen Property <br />200 S. Cherokee <br />TANK ID N'39-SOR635 TANK SIZE: <br />E.P.A. n CAC 001463568 <br />Lane, Lodi, CA 95240 <br />350 gallorftEVIOUS TANK CONTENTS: Waste Oil <br />♦aaaaaaaa•ar#ar+++}ar#}a}r}}arrr#+#ria#++r}#r+r#}rr+#rlr4#}r!r!!#!#+f#4fl44li+i►fl►if►44►f4f•ff►4fff►4f4►►I <br />SECTION 2 - 1'o be filled out by tank removal contractor: <br />tank Removal Contractor: Jitu Thorpe 011, 111C. <br />Addhess:_ 351 N. Heckman lid./P.O. Box 357 City: Lodi# CA Zip: 95241-0357 <br />Phone N: (_ 209 ) 368-6175 Date Tank Removed: <br />CT <br />aaaaaaaa aa+aaaa+++aaarr+laFr}}ir#rl+++#r}flaarr#arrr!##!a#+ilia+}#rr4++}rrrr♦+ar++r+iilf►►l4fff►44444!44444 <br />SECTION 3 - To be filled out by contractor "deconlaminaling lank": <br />Tank Decontamination Contractor: Jim Thorpe Oil# Inc. <br />Address: 351-N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br />Phnne N: ( 209 ) 368-6175 <br />Andunized representative of contractor certifying through signature below that tire rank has been decontaminated in in approved <br />mnoner as required by Cal EPA. <br />Signature: Date a3 <br />'101i�a15aFY'ee`0#`all`�IUa9"f"`ail't`11`tl"0 amn'va+or's'1, Off" ` """ " <br />$ tri i h detiveol �o' c�init gr,tee . <br />SF,C'ITON 4 - "I'o be signed and dated by an solho xe represenla vapors of the treatment, sto age, ar silos acil ry <br />accepting tank and/or piping. <br />racilhy Name: Schnitzer Steel I'VO(ILIct.s <br />12000 Folsom Blvd. <br />phone N: ( 916 ) 985-4810 <br />Dare Tank Received: (71 M 14K <br />Mame: <br />Rcuncho Cordovan CA <br />City: Zip: 95742 <br />•}a}}aaaaa+}a#}arrrra}i+++;r}a}a++a}}}}}}Parr}}}}rf}}}}}}}}}a}}}}}}}}}♦ <br />Ell 23 046 (Revised 9/11/96) page 10 <br />)-,?/ �K <br />