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PUBLICSERVICES Qf �Q <br /> • SAN JOAQUIN COUNiT = <br /> JOGI KIIANNA AI ll,M P If ' <br /> Health 011Kc1 � <br /> PO Box 7009 • (1601 Ful namlton Avdmc) • S10410n,C&100"A 9S2pi <br /> (209) 468 3400 <br /> UNDERGROUND TANK DISPOSITION 1RACKING RECORD <br /> SECT(ON l - PublicHealth ervicei Tracking ed l Public Ileaeet ll cconip&ny each tank r 0 d <br /> 1510be return 1M of acceptance of the lank te lby the disposAI Of lecycllug <br /> I racking Sheet Is to <br /> facility 1110 perlttil holder Is fespongiblc (of ensuring that tIlls (01111 Is completed and returned <br /> FACILITY NAME: Mildred De Vinceczi <br /> FACILITY ADDRFSS 21167 `liretheway Rd Acain Cal <br /> 7 ANK ID #39 - lI•lion 550 gal regular gasoline <br /> 3 _v Tank Descr <br /> •••f111if11.1//1••Iif•11••i/i•liii(•Iii••••••i11f•/i•••••••i/••••i•••••/i/•••••►•/•/••••••••/••••i••••1//• <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> Tank Removal Contractor. <br /> City Zlp. t <br /> Address: Pn <br /> f �] <br /> 0 Phone 0:: <br /> (_?n )— �h h 175 Date Tank Removed <br /> r - <br /> i•/••••/isit.i•Ii•i11•f•/ii•/•�;•/ii•••/i••/••••1••••/••••••,••/••••i••,•••/•••1••••/•••••••••11••(11••••1• <br /> SECTION 3 - to be filled out by contractor decontaminating lank': U Rich- art Co t I ctio <br /> lank Deconlatnloalion Contractor. o U <br /> Address: I Beckman Rd city. Lodi. , Zip 52111-035' <br /> Phone #: (20 368-61 5 <br /> Authorized representative of Contractor Certified <br /> ie Health signing <br /> Sefbelow <br /> l w that lite lank has been deconlantinated lit an approved <br /> manner as required by the State, Department <br /> 'I -- <br /> Signature; <br /> Stiff ION 4 . To be signed and dated by an o"lltori=ed rcpresallutire of the treaUnent, storage, or disposal Facility <br /> accepting tank and/or piphy <br /> Facility Name: Schnitzer Steel <br /> City Rancho CordovaZlp, 95(42 <br /> Address: 12 000 Folsom Blvd <br /> Phone N: ( 91� 6 } 985-4810 <br /> Vale Tank Recelved: <br /> 7ltle. <br /> Sign:tune; <br /> ••••••••••••s•i•/s/•••ss•s••/s•••••s••too <br /> •••/••�s'Page <br /> s1(1•••••s••./•••r••••••s.ss••••s••••••.•••••/•s••//• <br /> ra 23 049 ta•v 9/e/911 wp � <br /> A M111ar1 or San Jnrquln Caun1f ncl11h fuc krrlcc• <br />