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II <br /> t • �I <br /> SAN JOAQUIN COUNTY PUnLIC IIFALTII SF,RVICd <br /> BNVIR(RV gum IIRALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSI'T'ION TRACKING RECORD <br /> •!1♦.!HN!i N NN!!l/NINlNNNNNNNN1111/111NHINIIN NIfIN1NIHr11gININ lffrrfNfrf Mrrf 1777 <br /> SIUA I(IN I - roblic Dealdt Services rnvhonntrntsl Ileallh Division Tank Tracking Sheet shall accompany each lank sMited <br /> Willi 111 .10r. ldcntlllcadmt number. 1he Wank 'I'rackbrg Sheet IS to be returned to piddle Ilealth Servkes @nvironmental Health <br /> 11100,111 gllhlo_JO-days of accrptnrtre o/the Imtk by the disposal or recycling facility. The permit holder Is responsible for <br /> ensming that this form IS completed and teunned. <br /> I'ACII.ITY NAME: Cal Tank Lines, Inc. E.P.A. 9 CAD 004771606 <br /> PACILIIV ADDRrSS: 3105 S. El Dorado St . , Stockton, CA 95206 <br /> TANK ill 119 - TANK SIM:10,000 gal PREVIOUS TANK CONTENTS: Diesel Fuel <br /> I Ha.as aHI aaaHla♦HlaHNlaa!•!HN♦aNa♦H1♦N/11li/l Nlrl NIl♦IN•f NfrININrfIrrNN11�1►111111111111 <br /> SPAN ION t - 10 be Filled out by lank removal contractor: <br /> lank Removal Contractor. Jim Thorpe 011, lac <br /> Ad,hess: 3j1 N. Beckman Ild./P.0. flux 351 City: Lodi( CA Zlp: 95241-0357 <br /> Phone 1: ( 2U9_)_368-6175 Date Tank Removed: <br /> Haa.a a./NHNHlNNI/Nil NINgINN11HNNINNN NINN/IfiNfrrNrr MfrllNlf 1/11 N11NNrrf}gfrlf <br /> Sr(A ION 1 - To he Filled otrt by contractor "deconlamfi aling lank": <br /> lank Decontmninatbn Contractor: Jim I'hot'pe 0111 Inc. <br /> Adebrs,:-_-351_14. Beckman Itd./P.0. Box 357 —City: Lcxll, CA ZIp;95241-0357 <br /> phone 1: (_29-9—) 368-61'15 <br /> Authn,lrrd rrpresrtoadve or cnnitsclor cettirying tbrongh Signorine below that Ilse tank has been decontaminated In an approved <br /> rammer it trvinbed by Call NPA. <br /> flmne _ — Title: Signautre: Date <br /> a MM . ♦Ia ♦IIa1 !♦+ ♦ i/ HNa1/ ♦ 1/ NINE NNN /N1f Nlrf♦ I rfrN/ /• 1 ♦ ►fN/ **** 1111111 <br /> lal+k is free of aft �1ppdg� ana 1�ycl�oc�arGon vaX ti�lon d'I vert to "cin� Mgr eek. <br /> Sr(: 'ION A - 1'o be Signed and dater y an aul mr ze repre,enla live of file treatment, Stu age, or apm Gell <br /> scr-epting lank and/Fir piping. <br /> I°nrllhy Nmne; Schnl.l.zet• Steel 1'1'cxiucl.s <br /> i <br /> 12000 Folsom Blvd. Rancho Cordova, CA <br /> nddte,,:.--------- City: zip: 95742 <br /> l'hnne 1: ( 916 ) 985-4810 <br /> Me Tank Recelved: <br /> Signature: Datil <br /> N!♦./1♦!NH i!♦!!l1/ial NN♦NNNIii1N NINNNNIHNIf NIN►f/}IN rN IrfIr11N1►1/11111111g11111N <br /> II 71 n46 (Revised 9/11190 page 10 <br /> I <br /> , I <br />