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REMOVAL_2002
Environmental Health - Public
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EHD Program Facility Records by Street Name
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EL DORADO
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3032
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2300 - Underground Storage Tank Program
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PR0231093
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REMOVAL_2002
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Entry Properties
Last modified
11/18/2020 8:40:35 AM
Creation date
11/4/2018 4:07:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2002
RECORD_ID
PR0231093
PE
2361
FACILITY_ID
FA0003678
FACILITY_NAME
BULK TRANSPORTATION
STREET_NUMBER
3032
Direction
S
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
17702002
CURRENT_STATUS
02
SITE_LOCATION
3032 S EL DORADO ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\EL DORADO\3032\PR0231093\REMOVAL 2002.PDF
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EHD - Public
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08/12/2002 13:19 2094683433 FIFTH FLOOR RAGE 08 <br /> SAN JOAQUIN COUNTY <br /> ENVMONMENTAL HEALTH DEPARTMENT <br /> UNDERGROUND STORAGE TANK DISPOSMON TRACKING RECORD <br /> s*#!*ttt#tt#stfi*ti#tsx#*s*t#s#tsssfilitris:::t#!t#ts#tt#zwrtWSWwwwtrtkWwwwtwtWwiwiiwtsssi#R:s#sssifi#d:Rsssixsx <br /> SECTION I—SIC Environmental Health Department's Tank Tracking Sheet shall accompany each tank affixed with its site <br /> identification number. The Tank Tracking Sheet is to be returned to the Environmental Health Department within_30 dais of <br /> acceptance of the tank by the disposal or recycling facility. The permit bolder is responsible for ensuring that this form is completed <br /> and returned. 17 <br /> FACILITYNAMS: <br /> FACILITY ADDRESS: 3��1� S OL �'t''� / <br /> TANK ID#39- d l TANK SIZE: (Z Ie— PREVIOUS TANK CONTENTS; <br /> #W#W###kitkR#tY#i#tW###k##kttwWkk#Wiiiiii####*##t######w#kkWVWWWwVkiiikiii+Fur##x#sR#k#kiVVViiiiiwikikiiii.kw# <br /> SECTION 2-To be filled out by tank removal contractor: <br /> Tank Removal Contractor: <br /> Address: I6t�i f+GT„ 1 P t . �y,. /�LI'n'I'�G� yip; q ��� I <br /> -7`I LI y t 3 y Date Tank Removed: <br /> ##t#fizfiz#it*t�isififisi#x##titW#W#k##kk#kii#W####t##iz!##i3#i#wWkkiiiiiii###iYYY;tYkkki#iii####:sit##E#krti W## <br /> SECTION 3-To be filled out by contractor"decontaminating.tauk <br /> Tank Aecontarmnatioa Contractor. ' js-,c <br /> Address: ( 035— F,—Cn (n7. City. 1pa Zi 6N SO <br /> Phone#:{�o ) `/`I�l 139 F �J _7' Lt ({j CD <br /> Authorized representative of contractor certifying through signal=below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Title: Signature: Date <br /> ##ERE#siRtis###EE##xi###rt#W#kWNtiiwViiiiM#i#s:tssxsR#t#k#wikikM#M##*tssiifiz#t##wWW#Mw*wi#ssiz###zlzW##WYwWW <br /> SECTION 4.To be signed and dated by an authorized representative of the treatment,storage,or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: <br /> Address: City: Zip: <br /> Phone#.(� <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> #t#sH###isiiitlti###ss#t###W##iiiwiikwwwxx*s#s##t#x####W#W#W!#iki##izss##kWWWWWWVk#Miit#isRRiitt####ki## <br /> Ell 23 046 (Revised 3/15/02) Page 10 <br />
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