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' I <br /> SAN JOAtPON COUN'T'Y PUIILIC IIEALTII SERVICOS <br /> ENVIRONMENPAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> �rrq++•++rrrr#+t+++tr+++•r+++++++rrtrgr+r+r♦rtNgr►r►rq►►►r►NN►►1►►►►►►►Ne*►H►► <br /> SMI WN I - Ihrbllc Ilealrh Services Envitonmemal Ilealth Division Tank Tracking Sheet shall accompany each lank Affixed <br /> with Its site identification number. the Tank 'Tracking Sheet is to be returned to Public Ilealth Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder Is rrspoasibie for <br /> ensuring that this form is completed and returned. <br /> MCILITY NAME: Hutchins Street Square E.P.A. q COC 001239520 <br /> FACILITY ADDRESS: 121 S.. Hutchins Street, Lodi. CA 952AO <br /> 000 alio �ptPi <br /> I'ANK ID f l9 - TANK SIZE: 3, g rMEVIOUS TANK CONTENTS: p4 bunker oil <br /> ,#•a•H a«#sats•##++aNNM+♦+++rrr H+4+TMH«#1+!!rNrMrM+HN♦!r♦Nrr+►larraMra►•N►r►►1►►►►►►►�►M►►►* <br /> SFC'IION I - To be filled out by lank removal contractor: <br /> Tank Removal Contractor: Jlm Thorpe 011, Inc <br /> Address: 351 N Beckman Rd./P.O. Box 357 city: LodIfCA zip: 95241-0357 <br /> Phone IF: ( 209_) 368-6175 Date Tank Removed: - /A - l 550 <br /> #HHra•#arra##++!!N#a++a♦r!r!#++a+rr!!}!♦+lMHNNrr4M r#♦r++M♦♦•a M M+r a«M+4+♦+l+++++rrrrr+4♦rrrrrMa <br /> SECTION 3 - To be filled out by contractor "decontaminating lank": <br /> lauk Decontnmination Contractor: <br /> Addrese: City:__-- ZIP._ <br /> Phone J: <br /> Ambodird represenintive of contractor certifying through signature below flint the tank has been decontaminated In an approved <br /> manner as required by Cal EPA. <br /> Name: Title: Signature:__ Dete <br /> , r+a + ++ + «+ a+++ lra++!♦+aa ♦ ♦ rr+ ►ra♦ as►ilia <br /> 3r-(TT-(-)N-T- o e sisnrd and Tal-FTFrMatilliffililed repi men a ren a treatment, s o age, or disposal ISCHIT <br /> arreptlnq lank and/or plping. <br /> 'ncllltyName: _-_ Americlean, Inc. <br /> 2370 Almond Dr. Silver Springs, -NV 89429 <br /> Willem City: Springs, -NV — <br /> 'hone /: 800 ) 471-2105 <br /> late 'tank Received: �/( , pr/ / <br /> lank/ /us _Title:_ Signature• rra Date <br /> .a#«.rrla+++a+#a♦+r+arwrr♦rra«#«a«r!r#!«ra+l+!!!!+•++♦««+silt+•+aar♦rawr!♦rrrrNrq♦rrrarrrifNM►rN►M <br /> 1121046 (Revised 9/11/96) Page 10 <br /> I <br /> ) <br />