Laserfiche WebLink
SAN JOA TIN COUNTY PUBLIC HEALTH SERVIt-6 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> *+##+#+#+r++tt#+++##af+a#wragarrfa#+####a+w+##r##fwafrrfro++#rr#+oaf#rr#f!####r!r#a#+#####################r <br /> SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with 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: JUNE KEMALYAN E.P.A. 11 CAC 001244600 <br /> FACILITY ADDRESS: 5328E Acampo Rd Acampo, CA 95220 <br /> TANK ID N39 - N/A TANK SIZE: 550 PREVIOUS TANK CONTENTS: gasoline <br /> SECTION 2 - To be rifted out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 Date Tank Removed: May 1 , 1997 <br /> SECTION 3 - To be Pilled out by contractor "decontaminating tank": <br /> +t <br /> Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beclanan Rd./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br /> Phone p: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Martin Thorpe Title: Vice-President Signature: y,- Date May 1 , 1997 <br /> '1`dnk* <br /> is ree`0 `a`�I`s l ua gfes an`�"hYa roCarpon vapors`upon##d`e`I iverV`Lo#SC(1ni tZr;J teeM`#`##r <br /> SECTION 4 - To be signed and dated by an aur orize representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. City: Zip: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Name: Title: Signature: Date�� =2:7 <br /> +*+##########++##ta+t#t#+++++*++#####l4fa##t#f###ta#+far#+i+#ti+w###ffa+a#a#ria+#aa##+r##f##I#fa#f+oaf#►r <br /> Ell 23 046 (Revised 9/11/96) Page 10 <br />