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t <br /> SAN JOAQUIN COl_1NTY I'Ui1L1C I11FAL7'11 SI RV10E3 <br /> ENVIRONMENTAL I1FALTII DIVISION <br /> ITNI)EItGRO(jNi) STORAGE TANK DISrOSI'TION TRACKING RECORD <br /> Sl t:"l"lt1N l l'1+hilr. lleakh Srrvlces FlIvilnnnlental Ilealth Divistnn Tank Tracking Sheet shall eeeompany each lank affixed <br /> �airh Its site tient{ficatlrrn nnrnhcr, The '1'artk "1'l lrkillg Slleet i.1 to be renllned 10 P4lblic lleaith Services Environmental Health <br /> Itivisi.)++ +Birth 30 cinys of Arrr.nt:tnrc of ric tank by the disposal or recycling facility. ue permit holder is responsible far <br /> e11511thig that 1111.1 follil 1.1 Completed and returned. r <br /> I'A(:I1.I1Y NAMli: __Connell Motor Truck Co. , Inc. L.P.A. # CAD 3816 <br /> 17ACILI l Y ADORP.3.1: 2211 N. Wilson Way, Stockton, CA 9520: <br /> unleaded gasoline <br /> 1AVIK 11) #19 - -- —TANK SI'zr: 10,000 gal.-PRFVIOUS TANK CONTENTS: <br /> Fr.•arra+ r++++++++a++++t++4++###441#+++++tit*+t+tt+t4t4t+offtit++#tt#4*tt+441!*###*i#*#**#*�*'�#'�***##**'�###* <br /> :Slat;, ON 2 - I() be filled out by tank rerrrnvlrl contractor: <br /> lank lternr)val Cotltraclor: Jill] Thorpe 011. 111c. <br /> Arldles.1'_.__3 1_ ._Liecl<matt <br /> Rd./P.P. Box 357 City: Lodir {A Zip: 9524 1-0357 <br /> Thune U ( 209 -? 368-� I j.? I}ate 'Tank Removed: <br /> S1+,t:'11ON 3 - Tn he filled nut by coutaclor "decontanrinnling lank": <br /> hIIk Uernnl:+llllnatloll Contlactot: Jill] Thorpe 011.1 ttic. <br /> Arldrrss: 351 IJ. 13culunan lid./P.O. BOX :357 City: Lodi, CA Zip:95241-0357 <br /> I'hnnr. a: ( 20y 1 :368-6175 _ <br /> Awhori?.rrf iri)trsrnt:ltive of crrllttactor cetlifying Ihrnllgh signature below that the tank has been decontaminated In an approved <br /> nt7,nirr as trri+tited by Cal FPA. <br /> I'fartrr!:__ <br /> l itic: Signature: Uate <br /> a <br /> J*k+ rr.+�a+ 4++e3#♦ t4+ 4 t# 444 t+i# + #t t##444 ###44####44#tart###4 # M***►#liilriwia a}oras+�iaaa►fMf*iM*�* <br /> an�C 1 s reQ t7t a � �� yes artii �tyyc v G'arson va mrs t>11ton Te very <br /> SF,c l]ON 4 - 'To he sinnrd and dated by an atrtfindied represents lye of rite treatment. storage, or disposal ractllty <br /> acrrptittq tank and/or pflting. <br /> rility hl ln,r: West Coast 1,;quipprnt _^ — <br /> 1�trl ock 95381 <br /> Arfrlress, <br /> p.0. Box23C�fi —�� �. City: Zip <br /> Dille Iank Receivr_rf: <br /> tlantr: Title: Signature: Date <br /> Feil 23 TIG (Reviled 4111/96) page til <br /> t <br /> .j <br />