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. l <br /> SAN JO.11N COIINI'V rUD1,lC I1FAI,TIi MAIM' <br /> FNVIROMAIMI'A1, DF,ALTII DIVISION <br /> UNDFItOROIIND STOlIACF, TANK DISrOSIT1ON IRACKM RECO" <br /> ♦♦♦♦♦♦HIr N♦♦M1♦rNrlNlNrfNN♦wNlrMHNrr Mw♦wlrNNIM♦♦♦w♦♦♦f♦♦♦I♦N♦NNNM♦♦♦♦♦♦♦♦♦*♦'�♦♦"��♦♦N� <br /> Art'IfrfN I . 1`nhllr Ifraldf .Setvtrrs 171.1101nnmrntnl IIra11h Dlvitlon'I'aok T'rnrklt,R Shrel shall accompany each lank mMoted <br /> v4df Ili the Irlrolliff afinlllollob". fife lank loacklnR Morel h to be te000ed In roblic Ilealth Services Invironmenlal Health <br /> DIvltlnn allhhl !Q flava of arcrpfnre or life lmlk by file disrmal or recyrling farlllty. The permit holder Is responsible for <br /> orsofbf7l flint fitly forst Is ctnnpleled Aloft lettnoed. <br /> 1'ACII,IfV NAh11?: Van De Pol Enterprises I;,r,A, p CA0002102104 <br /> I'At:I111YAllIIRrSS: 3230 N. West Lane, Stockton , CA 95204 <br /> ---------------- <br /> IAIIK Ill #19 . ,�pprpp-�d 7 IANK SIIP: 10,000 9:1,11IRVIOt1.S TANK CON'1'1?NTS: Gasoline _ <br /> u♦l.l♦.H♦!♦NH{1♦!♦!Nf{MN NrH NNlf HIfMMrrf♦Nr♦NNrrr♦♦♦♦♦!!rN♦♦♦♦♦*♦♦♦♦ ♦�♦*, • ♦eeel♦v��F'. <br /> .Ili,(:I ION ). In be, filled out by ("Ilk lunovnl rtntfrncfot: <br /> Imfk Renorvnl Cnntractot:_ Jlm 'I'llorve Ull, lllc. <br /> Arbhrm yjl U. BecktnallHd./I',U. Ilox J5'7_.__.__-------_• Chy; Lud�CA zip: 95241-035'1 <br /> Phone 9: ( 1Oy _)—JGU–G 5 Ime Tank Removed: <br /> /.......a♦.f a♦!♦♦♦a1a♦♦IN{N!{raN♦♦N♦{rNNrr♦{fNN♦rNrrN}aMNN}♦♦♦♦♦f*♦♦aMN♦M►♦N♦M♦*♦*♦♦♦♦♦♦♦ <br /> Sp(:' ON .1 - 'Io he filled not by rnnftarinr "deconlandnnllnR lank": <br /> lank Irrr.nnnmbrndon Cooltnctot: Jlul 'I'hot'pe of I , Inc. <br /> Adrbr..m J51 N. Beckman Ild./P.0. Box 351 City: Lodi, CA Zlp;95241-0351 <br /> 1'hnnc 1: ( 209 ) JGU–G 1'15 <br /> Anrbml7rd frpfrlrnlmlve of cnnnactor cefilryfng rhmugh signature below that file lank has been decontaminated In an approved <br /> ulmorrr at lrgohrrl fry (:al ITA. <br /> (Innen: Tifie: Sagnanne: Date <br /> .y.II .•Irr NMif /♦♦ ♦ {♦ ♦ NI♦ ♦ 4f ♦NMI} }♦rf}}If*/M frfN} ♦ ♦}♦M♦ ♦♦ ♦ ♦ ♦♦♦♦♦ ►♦♦♦ 0110♦♦♦ <br /> IRII�C is (ree ni err 1Yti �i r�nA lot I0�11t+ Mliva1rnrs St�lon c>•e�iverj to r��n��;fgr $�,eei. <br /> Sr,C 1ION d - In hr slgnrd and t al r ry Alt std lot re tern" nla Ire of t c treatment, sio age, or posa mall t <br /> arrelrthft lank and/tar piping. <br /> rncllhy llmne; S fIl I.I.7,VT 31.re.l ITU(III .-I <br /> I?.(IBII r'o1s(rn It.lv(I♦ Ilrmcho Cordova, CA <br /> Arinc�tst ---- — — Cily; zip; 95742 <br /> Phone /: ( 9 IG ) 985--41110 <br /> Mr, Infk 0efrelvrd: <br /> Imnrt 7Ttle. SI nsmro: Uele <br /> H14+1000♦H♦11♦HH H.♦♦!♦♦.♦♦M♦♦♦♦!HH♦auf♦♦aY}♦♦aHH/♦1♦♦H♦4Hfa♦H♦{Nrraf w♦♦rMrrr}rr}wff}rfrf <br /> 11 21 0,16 (Revised 9/I I/9(j) rage IO <br /> I <br /> 1 <br />