Laserfiche WebLink
SAN JOAQUIN CO11Nf Y PUDLIC IIF,ALTft SF,RVICES <br /> ENVIROMAIPMAL IIFALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ...+..rr!♦+H+N++++rN♦♦+++♦++♦!r♦#♦♦+++Hr+rH♦r+w+♦#♦♦#!+♦}HlNrrN#N}#}#Hr}}}}}N♦}}}....*�.*�N}}. <br /> ^.fr'I ION I Piddle Uealdl Servicd rnvhonmannt llralth bivhlon Took Tracking Sheer shall accompany each lank rfRxed <br /> wilt Its sire. life.millcarlon number. life 'Tank frocking Shret Is ro be tenoned to public Ilealrh Services Environmental Ilealth <br /> NlVfsion 11,101111 JO dev.5 of arreptanre of the Milk by life disposd or recycling facility. The permit holder Is responsible for <br /> routing dint this firm Is completed slid rcumted. <br /> PACILIIYNAAIE: Van De Pol Enterprises E.P.A. h CAC002102104 <br /> I'A(:11.11Y AIMPPIS: 3230 N. West Lane, Stockton, CA 95204 <br /> TANK IU A19 -btAD0_'2 + TANK SIZE:-10,000 9�04pvloUS TANK CONTENTS:_Diesel Fuel <br /> IIyy�tQQQW- <br /> ...N r.N r.+++♦H r}«+♦!M!Mr+l+#rl+++l+IM r!!MI}}#!!}rl+r}r M♦N+MI#!!#r./:}K#}##q.##.a.1!}}#+#}}!#}+}+} <br /> SECTION 2 - '1'o be filled nor by tank removal contraclrrr: VVVV <br /> link Rennovnl Coolractor._ J1111 TllorpC U11r 111C_ <br /> Addrrss: 35.1_ N_... Uecluaan lid./P.U. Box J51 — city: Lodi, CA Zip: 95241-0357 <br /> Phone N: (_.ZUy_) J6U_6 V15 bite Wank Removed: <br /> ...«.«...««r....+♦«+r+♦♦r♦♦♦♦♦♦++r+♦++♦♦re.++#♦+!♦++rrrrr♦re.♦#♦#+r+r!}AM!###}}#}####}}}}}}}#.q..4..Rf..4aH• <br /> SE(:'l ION J - To be Riled out by contractor "decontondnnling lank": <br /> lmtk Contractor, Hill Thorpe 011, inc. <br /> Addte.tt: J51 IJ_ IJeclanan Intl,/I'.0. Box 351 City; Lodl., CA Zlp;95241-0357 <br /> Phone 1: ( 209 ) 366-6175 <br /> Ambatlzrd trptcsrntnrive of contactor certifying through signainre below that lite rank has been decontaminated In an approved <br /> Instiller ns regnhed by Cal EPA. <br /> Ilnnrr.: ___ 11t1e: Signature: Date <br /> . 4 +}♦ ♦ ♦! }!!♦♦#} ♦ #+ !♦r##! }!A}#}}+!}!rlAr+### # }}}}}} }# . ► #}#.. •...!l...... <br /> 1 ill is tree oiga f f 1 u11'rgy all o V,1 j-ojar�oil valiors u�)on Je f�verl,age 11 *11i�garcll�r�ee l . <br /> SEC'IION d - 1'o be si tied and Baler an alit 1m xe re resents Ire oft a treatment sro a e or <br /> accepting Iank and/or piping. <br /> 1'nrllhy Flmne: SCIIIIIA.Zer Sl:eel Prodlict.s <br /> ---- <br /> ------- <br /> -- — - ; <br /> 12000 Folsom Il.lvd. Rancho Cordova, CA <br /> Address:- -- --- — 01y: Zip: 95742 <br /> 916 1 985-4010 <br /> Tarr- lank Received: <br /> Isom: —__17de: Signature: bete <br /> r«+a4rr«r«+++r+♦♦++stir+++a+Al+++r♦+++l+r+r++#r♦++r++r♦+♦+r♦+r«♦ar♦+•+re.♦+r#+r+#+++}#}##}#r+}M}}}}}f#}}} ' <br /> It 23 040 (Revised 9/1l/9S) tinge 11) <br /> i <br /> 1 <br />