Laserfiche WebLink
r I <br /> SAN J0*gI11N r.0IJN`rY PODLIC IIRAI,T1l SISRVIrb <br /> ENVIRONMENPAI, 111!AL1'11 "IVISION <br /> 11N1►FRI:RUlIN11 51'ORAGR TANK DISPOSITION TRACKING RECORD <br /> ..a..•11•«••H!HHH«•••H•♦«N•♦N♦a•F•«H«H«H••••NH••N«♦•H••HMHN•N#f1f•ffffffff••.•M••••••• <br /> Sit tION 1 . Muhllr. Ilraldr Srrvkes pnvhmauemnl Itenldr Dlvislon Tank Trackhrg Sheer shall aecnlrgrany each lank affixed <br /> with If rtrr Idrfit llrndoo masher. the Took 1'cMCI log Sheer Ix at be rerutned 10 Public Ilealth Services Environmental Iledlh <br /> Ifivlslnn nlUiln JO, of arrrptnnre of rhe rank by fire disposal or recycling facility. The permit holder Is responsible for <br /> enorloR Ihnl Ills form Is completed Mrd relarned. <br /> ('AC11.11Y NAMP: Van De Pol Enterprises I:.11.A, IF CAC 002100064 <br /> MArll.lIYADD1rS.S: 3147 S. El Dorado St . ,_Stockton , CA 95206 <br /> IANY. 11) /19 - � =Q TANK SIZE: _10,000 ga)rREVIOU5 TANK CONTENT'S: Unleaded Gasoline <br /> ...............•••..••H•1♦♦•aHHHHf.•.•.•«F#.«.•.{•.•.••«#««•••••••••••••MNMNNN►fIN••ff1H•Hf•• <br /> Sf!(:1ION 1 - lobe filled oat by lank removal conhactor: <br /> 1 cork lemovnl Conitachrr:_ J1111 11101'pc Ull t 111C. <br /> Ad.hrss: ...J51_N. Uecknlan lid./P.0. Dox Y�f City: Lodi l CA ZIP!-9524 1-0357 <br /> Thant M: ( 209.... )-.. J6D-6 I,75 '_ Uare 'rank Rearoved:_ I y I <br /> T <br /> /1.•a•F/H•H•H1.FF«♦♦#M#!#•MfN•••««••{••♦#1•«#H###N«#••N•M♦ff{IfMfff####•#f##Mff#fff f•♦f•INN• <br /> SI!1:'IION J - To he niled Coq by contractor "deconlandnanog lank": <br /> Innk Irrrommnlnnfion Conoorinr, JJ.nr 111orpe 0111 l.nc. <br /> Arldrrsr: J51 14. Declman Ild./P.O. Dox 357 _ City: Lodl/ CA Zip:95241-0357 <br /> Minor A: ( 209 ) 3613-61'15 <br /> Andnnlrrd irprrscalallve of conlraclm cetllfying lhrough signaune below that the lank has been decontalnitnled In an approved <br /> mnooer as trgohed by Cal PPA. ,7 <br /> IlMne:_-11'►>aka•-1ft,'Jig '[tie! V? Slgnalore bale la o <br /> 4. . j . ...lip:...f •.• p1.. •�'Ilf �. .. ......�.#... f#.. f fff . .• ��n�Mfr ee�•••••.• <br /> 1 aft k is a o1 a f( �1p1 6 �nr 8 o arfirnt va tors f mn Je«ver �o <br /> 1" 11)14 4 - fn h, slgnrd and dal r ,y Mt au m ee represmU Ire of l e treatment, at age, er pox ar l <br /> acapdn�Innk and/m piping <br /> Mnrlllry Itnme: Schnl.l z.cr_,I,ecl I'r cxhrct_s <br /> I?ODU f'olscrn It.lvcL Ilmicho Cot-lova, CA <br /> Addrrss: City: Zip., 957112 <br /> 1'hnne A: ( 916 ) 911'i-.1113 1() <br /> Dale Innk nerrivrd: ---- <br /> Namr: 11Ue: Signature: Date <br /> {1.1••/••H«««1{•{1!«HH«{{N#{fN««#Nf•NHF«•#♦N#MN#♦M# •#f•H###N•«•«{N«##♦f♦##14111♦#1111##ff <br /> PIl 711),10 ("eviler 9/11/96) page 10 <br /> l <br />