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SAN JOI�.'014 COUNTY PU11L(C IIEAi,TTI SFRVI <br /> F,NViRONMFNTAL 11F,ALTiI DIVISION <br /> UNDERGROUNi) STORAGE 'TANK DiSPOSi1TON TRACKING RECORD <br /> aaaaaa+a+a++aaa+awa++aaaraaaaaa++aaawaaa#raaar+ra+aaarar+arra#tart#4#a++*####4#4+##44444#4#444444*444444444 <br /> Sr(:'l lON l 1'nbitc lleaUh Servicer Fnvironrttental liralih Division Tank Tracking Slteet shnil accompany each tank affixed <br /> Milt Ile Or IrirntffIrarinn number. the lank Tracking Shret is to he returned to Public Health Services Environmental Health <br /> I)ivfr,inn trf(itln_JQ-dnvs of arcrptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> r-nsurhtg Iltat this forrn is completed and returned. <br /> rACli,flY NAMF:__Ra_l_ph_j arkPt C.P.A. 11 CAC inn <br /> r'A('11,1 rY AF)1)RFS.S: 2122 S. Airport Way, Stockton, CA 95206 <br /> TANK ID a39 - 1nOLI-03 1-ANK Sr7F: 5,000 gals. PREVIOUS TANK CONTENTS: gasoline <br /> iaa«+aa+a++a+a+a+wa+a+aaa+a+aarraa+awwaa+a+♦aara+a+#+aa+a+aawr++#aaa♦+aa#+#*+###+#########.#44#4#4!4444#!44# <br /> 4fC'11(JN 2 - to be filled out by tank removal contractor. <br /> lank Rr-moval Gmtractor. Jltn Tilorpe Oil, lnc <br /> Address: 351 N. 13ecktnan lid./P.O. Box 357 City. Lodi, CA Zip: 95241-0357 <br /> f'Itnur, a: (-.209 —)-368-6 175 Date Tank Removed: <br />««aa«.««aa+aaa++a+++aaa+aawawwwwwaaaaaaaawaaraaraar+♦aaraa+a+r+aa+rrr#####r######w#####!#!#!!44####44##!#!# <br /> SFC'TiON J - To be rifled out by contractor "decontaminating, tank": <br /> lank Dr_conrarnination Contractor. Jint Thorpe Oil, Inc. <br /> Address: 3131 N. Beckutan fid./P.O. Box 357 City: Lodi, CA Z(p:95241-0357 <br /> Phone b: ( 209 ) J68-61'15 <br /> Anthnti7rd rcprracnrative of contractor certifying through signature below that the tank has been decontaminated In an approved <br /> manner as terinircd by (.,if FPA. <br />'larnc: 'Y�,2f i�. �,o �e 1-i <br /> tle:� l/ Signature `�'?�—. DSte <br /> +a+++ +wa a♦ wa •++aarr + r+ a#ar#a +aaa##+#++##+a+###a ♦ t#####♦ 44 !4 4�4►l444 ###4 444#4#4 <br /> latlfc' is tree of air suc ges an �tfyc�ro�Carpon vapors upon delivery tocd �rtee . <br /> ihC'11ON 4 - -To be signed and dated by an ant torize repre;enta ire of the treatment, ata age, or usposa acil ty <br /> accepting tank and/or piping. <br />:arility Na►ne: Schrt.itzcr :steel Pt oducts <br /> i ,itrcho Cordova, CA <br /> Mdtcss: 12000 F'o l.scxn Blvd. City: Zip: 5742 <br />'runic A: ( <br /> 916 ) 985–/1810 <br />)atc 1-11uk R civcd: <br /> iantc: _ Title: Signature: Date <br /> fa+asaa+ <br /> ++`++aaaa <br /> r , <br /> fl 21 0,167 (Rr-vised 9/11/901) Page 10 <br /> I <br /> .) <br />