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SAN JOAQUIN COIMI'Y PUBLIC HEALTH SERVICES <br /> F,NVIRONMEWAL HEALTH DIVISION <br /> UNDERGROUND STORAGE, TANK DISPOSITION TRACKING RECORD <br /> H 4a«a 14\A•N♦aa+++4 a aaf tot+♦aff Na#Haff ata+}aff f f#1#♦♦l of lttff}#f trN#MMINM grf11♦rr11♦♦111111►11/♦1► <br /> SF( ' lON 1 - Public Ileallb Services Fnvitmonental Ileallh Division Tank Tracking Sheet shall accompany each tank affixed <br /> Willi IU silo Identllcaton number. The Tank '!'racking Sheet Is to be returned to Public Ilealth Services Environmental Health <br /> Divisfum Nillllu_30_dav3 of acceptance of the tank by the disposal or recycling facility. The permit holder Is responsible for <br /> eosuring drat this form Is completed and returned. <br /> IIACIL.IIY NAMI Reil)y's Car Wash I;,p,A♦ q CAC 001481312 <br /> m ll,fIY ADDRESS: 100 E. Lodi Ave. , Lodi, CA 95240 <br /> TANK ID A'39 - TANK SIZE: 44 oocg0 PREVIOUS TANK CONTENTS: Unleaded Gasol inn= <br /> 70 <br /> ««.«.+.+«++aaa♦ftlaaf+t#♦\fl+satttaafttaaaaaaaalaaat♦a#aaaal#aaf♦r+♦♦at•#t♦♦##ar/a1rt+/rrlrrr♦1111♦Ir♦rrrr• <br /> SECTION t - To be filled out by tank removal contractor: <br /> Tank Removal Contractor:_ J1111 1'1101'ue 011, Inc. <br /> Address:_35_1 N. Beckman lid./I'.0. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone A: (209 )_ 368-6175 Date Tank Removed: <br /> «+«a++++«arHH++♦+aaf4at♦f+Has♦#tf Maaa Mf M##H##f♦##Nfft#sial #1•#f4f+1lr}###Nf Nt♦rffrrf r#1 NrfrIM <br /> SKIETION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor. J1n1 Thorpe 011, Inc. <br /> Address:__ 351 N. Beckman Rd./P.0. Box 35'1 City: Lodi, CA Zip:95241-0357 <br /> Phone I: (--2U9 ) 368-61'(5 <br /> Andmnlzed representative of contractor cellifying through signature below that tire tank has been decontaminated In an approved <br /> manner as required by Cal EPA. <br /> Name:&'jc► p p )►t aA7t Title-APS Signature Date <br /> . «#♦ ♦ 4Ar ffa++# a+ ♦ fr ftlfaa# + at Matta f4alt#r##tf#}t##at/ ♦ !f#►1/ 1♦ ♦g♦ ♦/r4 r 1t111 11111+♦ <br /> I pis free oiga'Y� �luciye55yan111igif'oomon vaors apon tlae��ver g o rdi�p ea�fr,,tyei <br /> SFC' TON 4 - 1b be'O ted and dated Ir an and nor re representative of die treatment, sto a e orac <br /> accepting tank and/or piping. <br /> raclllty Name: Schnitzer Steel Producl.s <br /> 12000 Pblsan Blvd. Rancho Cordova, CA <br /> Address:_ City: ZIP: 95742 <br /> Phone I: ( 916 ) 985-/1810 <br /> Date Tank Received: -- 2 1 <br /> — ie <br /> Naar. _ _T'Ide:_ _Signature: Cf G/ Date7 ,Z-7 5f <br /> aH++♦aM NMfaf sal At Ha,«a+4Haiaa++aaa++++rr♦+H#H44r+++++++++r+NH+a Ma♦fNNa+tN#ff4###taaf l•#N♦t4 <br /> EN 23 046 (Revised 9/11/96) rage 10 <br /> i <br />