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t ' �I <br /> SAN JO QOIN COUNTY MIJIAC IIFALTII SFRVICKS <br /> FNVIRONAM11TAL IIFALTIl DIVISION <br /> UNDFRUROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> .arruaaa•Nr•000000000•rrrrrrwrrrrrrrrrrr+rrraaarrrrr•arrarraaa NaaraaaNaNffNgffNlffffffNffffMfNf1 � <br /> SrCI'ION I - Public Iteafdt Setvlcrs Rnvironntrntal Ilealih Dlvltion Tank Tracking Sheet shall Accompany each lank a fitted <br /> With its life Ideudlkadon nunrhrr, 1be Wank 1'rmrklng 511eel Is to be returned In Ptrblle flealth Services pevlrenmmltd Ned1h <br /> 1110.1lntl V0111111 JO days of arreptanre of the tmrk by be disposal or recycling facility. The permit holder U MponAlble for <br /> ensnrlog flint Ibis fotnt k completed and rennned. <br /> 17ACIIJIY NAMI%:Lincoln Unified Maintainence Yard 13,1'.A, #NM CAL 000049384 <br /> I'ACII,I I Y ADNRE.SA 6749 HarrisbUrR Place. Stockton. CA 95207 <br /> LANK IU J39 - Z—G TANK SIZE: 10,000 galloppFVIOUS TANK CONTENTS: diesel fuel <br /> l ua.aa r Harr•♦rr♦Nr•Mrr Nr•♦•♦w Hw MrrNHlrar HrwrrHr�rarwr•H"Naa M*NNaaf f►rNfHfl�ffff�IffMfMf <br /> SrC31ON 1 - to be tilled out by lank removal contractor: <br /> Holt Removal Onium tor._ J1111 '1'hot'pc 011, lnc <br /> Addtrsr.__,35_1 N. Beckman lid./1'.0. Box 351 City: Lodi, CA Zip: 95241-0351 <br /> Plnote N (_209__)__j6 I'l5 _ Date Tank Removed: <br /> a,....asr.aaaaaa0r•rar0aw0rww••0••♦rr•r♦rrrr•w••0rrr••rr•♦war♦rra0raaaaaaaaaaa*aaNa�lffNffffffffffNffff <br /> SFC LION 3 - to he Hlled am by emItAclor "decontaminating lank": <br /> funk Decmnnnlnallon Contractor. Jim Tltortle 011, frit. <br /> Addtrst: 351 tJ. Beckman Rd./P.0. Uox 35'/ City: Lodi, CA Zip:95241-0357 <br /> PhoneA ( 209 ) 366-6115 <br /> Amhatlzrd trptrtrmative of contractor certirylng dumrgh signature below that the lank has been decontaminated In ad Approved <br /> ntatmer at regnited by Cal EPA. <br /> (4mnr title: Signature: Dile <br /> tai(C'isarep aoi'aff'�1"u'd'p"'SalSt�'1'VIrrotarabion'3aator's"iipoliradef�very"�o JCffZfefrf so*ei�affff <br /> Sr(:11ON 4 - to he signed And date 1 by an aid lorized repteteMa�lve of the treatment, slotage, or AlepolAl feCll�l <br /> Acrgrtlng tank And/or piping. <br /> 1'adllty ffmne: Sclmtl.tzer Steel I'rcxiricl.s <br /> 12(l0U r'olsotn Hlyd. Hattcho Cordova, CA <br /> AddteIv _ _ city: Zip., 95792 <br /> Phone A: ( 9 IG ) <br /> 985­48 10 <br /> Date lank Received: <br /> Nantr Tlife: Signature: Date <br /> H•I aaHrrar••H••aw♦ara••rrr+•r rr•raH r•••arrrwrrr•rrr•r♦rrMrrr•rrrrrraraalaNNraaaNaaNfflffgfNfN ' <br /> r11 21 040 (Revised 9/11/90) page 10 <br /> i <br /> l I <br />