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SAN J0Ai1vIN COUNTY PUIILIC HEALTH SERVIC_ <br /> :ENVIRONMENTAL HEALTH DIVISION , <br /> UNVERGROUN' TORAGE TANK DISPOSITION TRACTK ' RECORD <br /> a+++;«++atwwwwwwwawaw#tawarra*w#wt*t#*t*#aatrwtattwt##+*#!##w##t***!#t#r!!!!#!+!*!►#*#*+#*!#***#ft4•####A*A <br /> SECTION I • Public Health Services Environmental ilealth Division Tank Tracking Sheet shall accompany each tank affixed <br /> with it.t site, identification number. The Tank Tracking Sheet is to be returned to Public Ilealth Services Environmental Health <br /> hivisinn sviddu 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible far <br /> enst+ring that this form is completed and returned. <br /> FACILFTY NAME: Delta Sign and Crane Service E.P.A. # CAC <br /> 2100 Sanguinetti Lane, Stockton, CA 95205 <br /> FAC111,11Y ADDRESS: CC <br /> TANK 11) #39 - I��7_-� r TANK SIZE: 1000 gals. PREVIOUS TANK CONTENTS: <br /> aaa+aaaa««++«+�+wrw+awwwtwwwww+awtt«rraMwawwrt*+R++wrf*+RR+Maw+f**rFw*w+i*r*###*#w*!##*##**r*#*#4#F##+Af#�!r'�"' <br /> SE,ty I'tON Z - To be Filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim 'Titot' e Oil Inc. <br /> Addtcss: 351 N. Beckman fid./P.O. Box 357 City: Lodi, CA zip: 95241-0357 <br /> Mimic �: ! 2U_) 368--6 17 5 Date Tank Removed: O - �`�' <br /> at+«+++++«w.w.«+a.a«aawawwwwrrrwwawrwwtrtraa«wwa«aaatwwrrraawrwat*r►wt#w**!rlr+F«rrrlw#####!!#*##!#!!!##!#!#+1 <br /> SECT10N 3 - To be filled out by contractor "deconinminating tank <br /> rank Decontatnination Contractor: Jitrt Thorpe Oil, Inc. <br /> Address: 351 N. Heckman 11d./P.O. Box 357 City: Lodi, CA Zip;95241-0357 <br /> Phoate 1: ( 209 ) 368-61'75 <br /> Amhot i7rd representative of contractor certifying through signature below that the tank has been decontaminated In art approved <br /> trranttcr is rerinired by GI EPA. <br /> p / p� <br /> Title: � l`td?i1� Signature: <br /> ` an�C'i s'f ree'oa aYfia's1 ugesa ani��y�`roawron avatpvr'sta ug ver veryr. o *'n i t*!`r#!tees!!!##.# <br /> SFC'I'lON 4 - To be signed and dated by an asst lorize representative of ttie treatment. storage, or 13"s 8C ty <br /> accepting tank and/or piping. <br /> Facility Name: Scttttitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 I:ol.sotn Dlvd. City:-.' Zip: 95742 - <br /> Phone d; ( 9 16 ) 9£35-4810 <br /> Date Wank Received: 1 <br /> Natne:.,� plw.,r - Title: Signatu • Date <br /> aa««rw«a.««w«rraa«wawawrrawawwwwwwwwww+wwwwwaa«awwww«wtwwwwwwr##rwtwwwt+r*#tett###r# ##!r##!!#*##!!!##!# <br /> f-ll 23 040 (Revised 9/11/96) Page 10 <br /> f <br />