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SAN JO'XOI11N COIINIT PUKIAC IIILAI,TII SRIIVICds <br /> FNvIRt toorttrAI, IIF,ALTII DIVISION <br /> 11N11F,RGROUNII 5I.ORAG9 TANK: Um5rO31'rION 1RACKMG RECORD <br /> •H•♦rNHHHra 1111 N♦11./♦♦NH/1111!rHH//r/MNaNM/lar/1•N1111111NIIIIIIf•IfflflffflMlf11f11f6411 <br /> 9t1:T1ON I pohllr. Nealdt lelvlcex linvhonmrolnl Iienllh Division Tank Tracking Sheet shall scell"Wili each lank affixed <br /> wirh lu shr Idrnrlflcndon nnotbrr, The 'Tank I'rnrkhrg Sheer Is to Ire rearmed 1n poblle 11ealth Services Brlvltellmemal 11ea11h <br /> 111011mt }rphlq 30 Mors of arreptnnce of the lank by the disposal or feeycling facility. The pe mll holder Is responsible for <br /> romobq dint 1111i Infill Is completed and relorned. <br /> PAC11.11Y NAMR: Van De Pol EnterprisesI".,p.A, / CAC 002100064 <br /> I'M 11.11Y ADORPS.4r 3147 S. El Dorado St . , Stockton , CA 95206 <br /> 10 000 a. Unleaded Gasoline <br /> IAM, 11) /19 - (�B�oJD _._I-ANK MIX: + g–t'RCv1011s TANK COWEN'rS: <br /> ,....••.••••...•r•a•♦/r•r♦•rlra•/rr••rlrr•r••/•Ia1arF./•/Ira.lila•♦r•♦r/11/•/1/1H►IIINI/NIN1/1NIMN1/f <br /> Sft:'IION t - In he tilled out by lank tegnnral contractor: <br /> lank Rnnoval Conhaclot: J1111 11101'pu 011, Inc. --- <br /> Addrriv J51_N.._Beckman lid./P.U. Box 35'1 , City: Loddii-tI ,C/A ZIP:_95241-0351 <br /> 1'lurne M: ( 209__.)- 360-6!1_5 _— Dale Tank Removed: <br /> {,•..+•.•••HN HH I•NNMNH}aN1NM•HMNI MIIININ NINIININ11fNIN1111ffflflllllllf1f11f1111111 <br /> SR(:TION 3 - to he tilled nor by contractor "decontaminating lank": <br /> lank I)eronmrninallon Conlfactort Jim Thorpe 0110 inc. <br /> Addlr.m J51 W. Becl:nlan lid./1•.U. Dox 357 City: Lodi) CA Zlp:952111-0351 <br /> Phone A ( 209 ) 368-6175 <br /> Andnnhrd teptrsenlallve of cmntsclor cettlfying tlmnugh signaltme below Thal the lank hes been decontaminated In an approved <br /> manner as requlred by Cal PPA. <br /> Ilmue:_f'yy .2F -P)�lUlf P� 1Ille: --- Slgnatnr <br /> eSa• a�'1 fa•�•1• /.....}.a/♦. Tor♦•*.♦./}/1�011p0a1�a1�aCI1�fIf�IM1af1 <br /> 1 U b rant d oldd4i',r bon vall)ol S 111Jhrn1 lveriy Go 11�t r ee <br /> .41: ION A - to Ire slgned and at r y an sm m xe reptesenla Ive of I e Itealmenl, Ro age, or <br /> accepting lank and/nr piping. <br /> 1'nrlllty Nmne; 5chnl.l.zr1• Steel Ih•cxlur_1.9 <br /> dress: Ilancho Cordova CA <br /> Ad <br /> 12000 Folsom Blvd. cloy: � Zip: 957,12 <br /> 1'I1fme A ( 916 ) ()Illi toll 10 <br /> tinge Iank Rrxrlved: _ aJ/g� <br /> Nmne: 11de: Signsmro: IOU <br /> bete `h ZS <br /> INH.{M•HMI MIIIH♦1HINM/MM Ml11HHHN1IMNIIIIMI/ /•MI/♦I/♦MINl1111M11111111111111111f1 '. <br /> Pit 111Nfr (Revised 9/11/90) rage 10 <br /> I <br />