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t <br /> SAN JO70011IN COIMI'Y PUBLIC DRALTll SERVICES <br /> F.NVIRONMFNPAL IIFALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ,H«1!♦+as+1 H H II a i H a++i++a ar#+##++♦+#+1+#of N++r+J a+r r#+++#Y#++r####►►rrrrrrr►rr►rrrrr►►►♦►►r►rr►►rrr►r♦ <br /> SFC'IlON I - Pablir Iieahlr Service P.nvhonnnental Ilealih Milton Tank Tracking Sheet shall accompany each tank afflaed <br /> Mill Its sire idrntificrrtloll number. life Tank Tracking Sheet Is in be renirned to Public Ilealih Services Environmental Health <br /> hlvlsinn within 30 Joys of acceptance of rhe rank by rhe disposal or recycling facility. The permit holder Is responsible for <br /> rosining that this form Is completed and returned. <br /> 1'ACIIJIV NAMIi: Reilly's Car Wash h.P,A. 11 CAC 001481312 <br /> rACILIIV ADDRESS: 100 E. Lodi Ave. , Lodi, CA 95240 <br /> TANK 11) #39 - _TANK SILP.:/d O6_PREVIOUS TANK CONTENTS: Unleaded rasol ine <br /> .,4«,♦a,a,a«a«a Vaa4a«Iaa♦aa♦i♦1#a#r#aa#««a«#aaa«aa##41rr#««#+t+rear#♦###i##++++#r##rr#r►►rrf�►►#r►r►►r►rrr► <br /> SFr:'IION 2 - To be nlled out by tank removal contractor. <br /> lank Removal Contractor: Jim Thorpe 011 I Inc. <br /> A41dtess: 35 N. Beckman lid./1'.0. Box 357 city: Lodir CA `)zip: 95241-0357 <br /> Phone N: ( 209__)_368-6175 Date Tank Removed: lit :O. ro �Cj g b <br /> ♦a„a,aa aaaaa+aaaia!««r«i#ai++alar##ra««ra#a#«aaaaa«##+r+#««#r##r#+++#####r+##♦++r#►#►r►►rr►rrr►►r►r►►►rrrr <br /> Sri:'IION .1 - To be filled ont by contractor "decontaminating tank": <br /> lank Deconrmnbnatlon Contractor: Jim 'Thorpe 011, 111C. <br /> Address: 351 N. Beckman ltd./P.O. Box 35'( City: Lodi, CA zip:95241-0357 <br /> phone N: ( 209 ) 366-6175 <br /> Aothmlzrd nrpresrolative of contractor certifying through signature below that the tank has been decontaminated to an approved <br /> manner as tegaired by Cal EPA. <br /> Nance:Q,�l r2p <br /> P. PC Title:�2es Signature: Date � l`1`}[Y <br /> . ,++ .•,«+, #a«+.+ «+« . r• rr/#+++ # +# •#+1## +#+♦##rr#►r#rr####• + ►+arrr r• ► ► r►rr►r rrrr qq►►► , <br /> lank Is Free of air �1Udyes ant 11�yc1ro�arfion va�ors a on c�ef�veroc��intgrtee�. <br /> lON 4 - 1'o be signed and deed by an aai mr ze representa lye of ilia treatment, sto age, or spos acil ty <br /> accepting lank and/or piping. <br /> Pacillty None: Schnitzer SLeel I'rocluCL9 <br /> 12000 Folsom Blvd, Rancho Cordova, CA <br /> Addtaa: City: zip; 95742 <br /> phone rt: ( 916 ) 985-4610 <br /> Dare Tank Received: <br /> planner _ Tide: Signatur Date Z� <br /> la+aaaalaaa+++++4«+1#a##r+rear♦ala+ar+##aa++#«#l+r4++++r+4#real+###aaa#+r!•1#+++►♦##rrrr►rrr►frit►rfrrrr♦ ,. <br /> iii 2J 040 (Revised 9/11/96) Page 10 <br /> I <br /> ) <br />