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SAN JOA.'JiN COUN'i-Y DUMC ITEALT71 SFRVIk. <br /> F,NViRONMFNTAL iIF,ALTII DIVISION <br /> UNDERGROUNi) STORAGE "TANK I)iSPOSTTiON TRACKING RECORD <br /> •++rla++r++tart+♦ar•+f rahra rff rfawfia#w++hihrhaaah4fif as##iia}#ail#ih##it#!i#!#!##t!#!######!##########!4## <br /> 9ECiiON I - f nhiic fie-lilt Setvicri Environmental itealth Division Tank Tracking Sheet shall accompany each tank AMxed <br /> vith its circ I�Irntificationmrrnher. the Tank Ticking Shcet is to he retuned to Public health Services Environmental Health <br /> lrlvi^inn tvllltitt 30 tines of arcrptnnce of the tank by the disposal or recycling facility. Tlie permit holder Is responsible for <br /> ensuring that this form k completed and retutne(l. <br />"A(11-11 Y NAME: E r A. It CAC nn(174�f�1h <br /> rn(:11.I I Y ADDRESS: 2122 S. Airport Way, Stockton, CA 95206 <br /> 1 ANK i1) A'19 - U U 2— i-ANK SIZE: 12,000 gals PREVTOUS TANK CONTENTS: gasoline <br /> ,,.,,„+++,a++a+ra+++araas♦rrr+riaar•+#+++a+#fhf h+fhrrirrww♦♦a+ai+♦a+i+##iti#ii##t#ir##!!#!##!###!##!!##!!! <br />)F(:'f ION 2 10 be filled out by tank removni contractor: <br /> I mnk Rnmoval Cnnrrnctor. Jittr Thot'pe Oil Inc. <br /> 1�Idre^s: 351 N. Beckman lid./P.U. Box 357 City: Lodi, CA/G Zip: 95241-0357 <br />'hrnrc a <br /> 368-6 175 Date "Tank Removed:_ <br />„,•aa�,+aaaa++++a+ara+w•arhaar arawaar af•araaraaraa4a#fawawiaiiaiia######!#+!#!!+!#!#####!#!####!##!#!#### <br /> iT CI lUN 3 io be filled out by contractor "decontnminnting Innk": <br /> ink Uccontnrninntlon Contractor. Jitn 'I'ltorpe Uil, lrtc. <br /> rlrlrc.^,e 351 N. Beckman 13d./P.0. Box 357 City: Lodi, CA Zip:95241-0357 <br /> 209 ) 36£3-61'15 <br /> 11r1101i7rd rrhrr;cntntivc of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> tnrmer n.s raprirrd by Cal EPA. <br /> note: +�1v R/IP 1'itle: I/ Signature:{/lex�7 -�� Date <br /> 1`4`0 $ �(ree.Otw a)rrws�u*#e5aw�n + rr af•i#i ia#afaiawh#a#sa##ai # rili!!t ♦! •##4 !##### ##!# !###### <br /> g ltfyc�roc�ar6on va�ors upon d�efi�ver o cd�tn t.f?r heel . <br /> t t:l lt)N 4 - in he signed and dated by an ant torizet representrtive of the treatment. sto age, or spos acil ty <br /> accepting tank and/or piping. <br /> rcility Nntne: Schrlitzet• Steel Product's <br /> f7tncho Cordova, CA <br /> Irlress: 12000 l czl sc_nn i31vd• City: Zip: 957.42 <br /> one 1 ( 9 16 ) 985-/1810 <br /> rte Innk R ved: j <br /> Title: Signatu� <br /> a+lair+++ ++r+a+�l,+� +ra+ra+affai•arf+af+a a+f+#i#aifiaiaaa+i+fii t#+#i#!!!####!+###################### <br /> 1 2.1 046 (Rcvked 99/11/90) Pnge 10 <br /> i <br /> 1 <br />