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SAN JOkjt11N COUPfI'V PURLIC IIFALTII SF Mt-911 <br /> ENVIRONMENTAL IIFALT'll DIVISION <br /> UNDFRGROUNI/ STORAGE TANK DISPOSITION TRACKING RECORD <br /> •a♦♦aa♦♦•r#r♦♦r♦#♦r#••r•♦•r♦••r#♦♦••rrr♦r#•r••rr•##r#•♦r•r•r#♦r#♦•r#♦#r1►NHNIIN►►►►1H1111111111NN111 <br /> 9TiC'1ION 1 - piddle Health Selvices Eovhonntemai Ilealth Dlvlsion Tank Ttacking Sheet shall accompany each lank affixed <br /> wldl 114 ,111r. Idrmilicntlon norther, the Wank 'hnrklog Sheet If to be rearmed to public Ilealth Services Environmental Health <br /> 11141inn W1011 30 flail of arceptance of five tank by the disposal or recycling facility. The permit holder Is responsible for <br /> otsuthtg that this form Is completed and mitnned. <br /> IWALIIV NAME: Fannie Mae Foundation EX.A. p CAC 001314624 <br /> 1'M:ILfIY ADDRESS: 25433 HLmice Rd. , Acantpo, CA 95220 <br /> IANK IU #19 - 'TANK SIZE:_ 350 PREVIOUS TANK CONTENTS: unleaded gasoline <br /> la.aalaaara♦r•♦Hr♦♦♦••HNrrH•##rr##NN•art•r##rr�►rrM/NM♦NHH►N4r►Nr1*IN►11N1Nf11M11111111►► <br /> .9 VC 11 ON t - Io be filled out by lank temovat contractor. <br /> Iank Rentovnl (:onuacnn: Jlm '1'ItorUo oil, lttc <br /> Addlrss: 351 N. Ueckntau Ili./I'.U. Uvx 357 City: Lodi, CA ZCip: 9p5241-0357 <br /> Thine f: ( 2U9—_) 360-6175 Date Tank Removed: �I t ct <br /> #a.♦aai♦04•-rMr#0146M#14#1►#IH#rrrNNl 44,•1.4#4#r##1#r►1•0I0I4/rNrr►ll►Ir#1#r#r HrrIMr1/#111►4M♦Ir11r► <br /> SEt"PION 1 - To he filled"tit by com(ractor "decontaminating lank": <br /> funk Derontnrnloatlon Connaclor. Jim 1ltorpe 011, Lnc. <br /> Addtrss: 351 14. Deckman IId./P.U. Dox 35'1 City: Lodi, CA ZIp:95241-0357 <br /> Phone ( 2U9 ) 360-6 17 5 <br /> Aafhntizrd trptrsnnadve of contractor cettirying throttgh signature below that the tank has been decontaminated In in approved <br /> om met as fcqulted by Cal PPA. n <br /> Nana:: tA�Dt01Rp2 lllle: P (Ze c Signatmre: __�L� IIe <br /> .## . a#+ ###.♦► ra# • ## N#•.r# ♦ ## •##### r#►q# ##IH #r1►#• r q►H• 1► ► ► r►111 ►►1► ♦111►11 <br /> lall fr 1s free of aft il1pdy�� ana 1�ytlrokarGon vaiiors �(�ton cl�I ver,, to nrn1fgr $�teef. <br /> SPC ION A - 1b he signed and data ,y an ami tm :e represents Ire of 1 e treatment, Ito age, or sposa acid <br /> ncceptbtg tank and/or piping. <br /> 1'ncilhy Nnme: Sdtnll.zer Steel 1'rcxktcl.s <br /> Rancho Cot-lova, CA <br /> Ad4ress:__- --_--12000 Folsw Blvd. City: ZIP: 95742 <br /> 916 ) 985-4810 <br /> Date Tank Rerelvedr '7 f <br /> Dile -7 <br /> #♦+Iu♦♦♦♦♦rr♦1♦Nrr#H•♦N♦rM♦M•♦♦rH##♦1NrHr#NHr1#11♦►Irri♦►MMIM►111111►►►►11H1N1111*1111111 <br /> 1711 U 04r) (RevW11 9/11 ) Page 10 <br /> I <br /> A <br />