Laserfiche WebLink
• t iI <br /> SAN JOAQUIN COWI'V PURLIC iIEALTiI SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDF,RGROUND S'T'ORAGE TANK DISCOSI'MON 111ACKiNO RECORD <br /> 4114111I4!lI14141+«414«••►++++•+a««•++l4►+a!«+4f+♦►►++«ffaaf«ff•fa«fflff♦♦♦iii♦•♦iiii♦if•♦••f•i•♦i♦♦♦♦•i♦i♦ <br /> 9hIA ION I - Publir Health Services 111101onoremnl Health Dlvl+Inn Tank Tracking Sheet shall Accompany each lank affixed <br /> Mill Its site Idcndlkadmtnumher, lire tsuk 'rrarklog Sheet is in be renuned to n1blic Ilealth Services Lndronmental Health <br /> Nlvimlon *1111111130 flays of acceptance of file tank by Ute disposal or recycling radilly. The permit holder Is responsible for <br /> ensotb,S dmI this rmat Is completed and tetunted. <br /> I'A(:It.IIYNAMII: Van De Pol Enterprises E.P.A, N CAC 002100064 <br /> I'AC1I,IIY ADORCS,S: 3147 S. E1 Dorado St . , Stockton , CA 95206 <br /> TANK IU I39 - _�Q TANK Sllr:-10,000 galknvI0U3 TANK CONTENTS: n4 1 >. <br /> .H1.1..H,•4.a4M HNN♦444««HN«M♦aaHN4«♦a1M«MMa►IN+lN++1H+Hf•Nf•if♦i♦♦4M♦♦iM♦♦1♦♦♦♦♦1♦♦♦♦♦ <br /> SfC'I H)N t - 1b be filied out by lank temovai contractor: <br /> Iank Removal Contractor. J1111 11roI'Ve 011, Inc <br /> Add,rts: 35.1- N.._ lieckntan Rd./P.O. Dox 35j Cily: L(di CA �zip. 95241-0357 <br /> ('hnne#: ( 209_) 360-6175 y---Date Tank Removed: � Z <br /> 1,u.H♦.•♦NaHM4a H4a!♦4+a♦N4.4♦HM♦««M•N4HHN♦NaH•aa•+a+a••aM••NiMi•♦i1♦i•i►•1f•}f4f••♦f••ff <br /> SPIA ION ! - To he filled out by contractor "deconlaminaling lank": <br /> lank hernotnmhtatlon Contractor Jim Thorpe 011, Inc. <br /> Mhhess: 351 N. Beckman Rd./11.0. Dox 357 City: Lodil CA Zip:95241-0357 <br /> Phone IF: 1 209 ) 360-6175 <br /> Anthmbrd trpresentallve of cottlraclor certifying through signature below that the tank has been decontaminated In in approved <br /> manner m tequlred by Cal RPA. <br /> (lame: to <br /> y► trV r�sr 1 F� T'life: <br /> . .f, . +r• H+aa« ♦a• ♦ ♦« • ►«♦f• • '111 <br /> aNN♦ ►Maas ►•Nf rq►►• f •fiN• ♦• ♦ • ♦i♦i1 ♦♦N ♦♦♦♦♦♦♦ <br /> 1alirc is tree of arr �iUd, f 4411ttyy<1'okarr, vaj101 i�dton defiverp io r��inl�Wfr �teei. <br /> Sp,C IUN 4 - to he sinned and date, ry an aulRnr se reprftenla Ire of t e treatment, M age, or spos act) <br /> accepting tank and/or piping. <br /> fnt-11byilntlte: SchnLLzer .^,I;eel I""luct.9 <br /> limicho Cordova, CA <br /> Arldtess: 17.000 rolstxn filed, City; Zlpt 95742 -_ <br /> Phone 1: ( 916 ) 905--4010 <br /> Dale Tank Received: —L L CI <br /> ,little: - __-- - — _Title: ---- Signature- Date <br /> ./•14.14MM++►444+aaaaM«+444«•+►••+a4MM•«««MrM•Mr♦a+•+M+MMM•Mf M•••4M«•M+M+MMM+•fr••+f• <br /> 1121046 (Revised 9/11/96) Page 10 <br /> I <br /> i <br />