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f <br /> SAN J07r(21JIN COIJNIT PUDLIC IIEALTII SERVICES <br /> F,NVIRONAIFNPAL IIF,ALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> +••++++•H•!M!•1♦!♦♦r♦+♦MNfrr++aaarr+M•+♦+MlM+MaM+laaMHaaaM+a ffMN•ff}fffM1•}M••M•�}}�Mf}•• <br /> .SF("IION 1 - I'oblle Ile.milli Set vices Ilenllh Division Tank Tracking Sheet shall accompany each lank affixed <br /> with Its site Idrmdltradon number. lite Tank Tracking Shed Is to be returner) to Politic Health Services Fant ronmental Hesith <br /> 1114110n wllhin-JO days. of accrptanre of lire Intik by lite disposal or recycling facility. The permit holder is responsible for <br /> rostitllrg flint this form Is Completed and remmned. <br /> pACII.IIY NA&fF: RrillyIG Car Wash E.P.A. p CAC 001481312 <br /> 1'AC11.11 Y ADDRESS: 100 E. Lodi Ave. , Lodi, CA 95240 <br /> IAfIY. IU /39 - _ TANK SIIE:S o00 PREVIOUS TANK CONTENTS: Unleaded Craso)ine <br /> •....•..••..«.•++•+«+r•+♦+«r«+«r♦Mrr+r«•M+M♦+♦rarrla♦rr+++aMr•MM+++aar+M+M+M M++fM}H••••MMMM <br /> SFc"1ION t - to be Oiled 0111 by Intik removal contractor: <br /> lack, Renmval Conuador. Jim Thot.pe 011.1rc. <br /> Addrrss:__-J�-I_N, Beckman Rd./P.0. Box .357 _ City: Lodi CA/ Zip: 95241-0357 <br /> I'hoor. I: (- 2U9--)__.360-6 1175________- Date Tank Removed: I'F'7 � <br /> •.•+.••••r•♦•+�+•�+«•++�HM♦•N M•♦M+«+H«♦•+•+�+++++•++..♦+r••rar++++++af►fff+++Maafr++f++lf Mf M+Mata+ <br /> SR(:'I ION I - Tit he filled not by conlracfer "decontaminating lank": <br /> lank Derommndondon Conttactor. Jim Thorpe 011, lite. <br /> Arlthrss: 351 11. Becl:ntall Rd./1'.0. Box 35'1 City: Lodi, CA zip:95241-0357 <br /> I'h0ne 1: ( 209 ) 360-6175 <br /> Awimiltrd trptesroladve of cmdtactor cerfifylog(htonngh signaune below dint the lank has been decontaminated In an approved <br /> umnnd a, tegolred by (.'at /FPA. <br /> llmne: RiC(t�(i ,l /v,y1 1'Itle: &e 5 Signature: Dale /s/l�� <br /> • .a-• r..+• aa•+•I/'+�+++ ♦TM •f+«+M + ++ +MM♦ M+Malmr, +a♦ f •erl, }f f • f•••1f ffff f}}f*}f <br /> lark is free l ned ft u(lye ant 1'yr1 oc(,arfion va fors aIvon d�ef�ver t0 <br /> SF,C ION A - 1'o be ,tgned and lafed Ivy an aulOotlzed represenfa�lve of Inc treatment, slo age, or silos aCll t <br /> accepting lank atid/rtr piping. <br /> I'nrllity 11mne Schnitzer Steel Prcxlucl.s <br /> Adrhes.e <br /> 12000 Folsom Il.lvd, rancho Cordova, CA <br /> ---------- _ Clly: ZIP: 95742 <br /> I'hnne I: ( 916 ) 985--4810 <br /> Utile Imrk necelved - -- --.._� �"1�`'i/ <br /> Iitte:_ Signature: <br />...•+.IN♦««NNH•+«M•M«rN+♦♦antra+M•+aMrMMM+r•arM++rMMNrlMaa Mfa+M•f•ffala Mflaaaafaffaaf '. <br /> EII 21 041 (Revised 9/11/96) page 10 <br /> I <br /> l <br />