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• r <br /> SAN JOAQUIN COUNTY PUBLIC IIEALTTI SFRVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDFRGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> «H++{{+{f{R+♦+►►H+a♦+►N+aa f►++M►M H+f1 f♦NN♦►►+N+ara MND++►Nf►f f f fMlff fffNf 1f I�f�r•r•4�������•i�� <br /> SEt:'1,1ON 1 Pabllc Ileallh Services Environmental Ilealdh Division Tank Tracking Sheet shall accompany each lank A flged <br /> with IIs site Idend(Icaton munber. The Park Tracking Sheet Is to be returned to Public Health Services Environmental Health <br /> Division nilhln J0.day-9 of acceptance of the tank by the disposal or recycling facility. The permll holder Is responsible for <br /> ensuring that this town Is completed and returned. <br /> ITACILII'Y NAME: Van De Pol Enterprises E.P.A. 6 CAC 002100064 <br /> IW11,11Y ADDRESS: 3147 S. El Dorado St . , Stockton, CA 95206 _ <br /> IANK ID #39 - TANK SIZE: 10,000 ga;IREv1OUS TANK CONTENTS: n; pgpl F+,ol <br /> 111 N!H V a 14+M+4♦+H a+►a++N f{M+•#N++f f+{#f M+++++♦►f N a►+++N►+a♦►►++NN►►N f f►f ff Mf1f�fNf fN�ffM+• <br /> SFC'I ION 1 - to be filled out by tank remittal Contractor: <br /> link Removal Contractor: Jim TIM-Put 011, luc <br /> Address:_ 3'51 N. Becka,au Rd./I'.0. Box 357 City: Lodir CA Zip: 95241-0357 <br /> Phone IF: ( 2UQ_) 368-61"T5 Date Tank Removed: <br /> 111«I!{f M#MMfaa#N+M►MNMr+r+rN#Mf++♦r+#+♦►M►4fa+M++a►•♦M►►►INf1flNffff•♦s►+#Nf►off►Nf►►fNf <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe 011, Inc. <br /> Address: 351 N. Beckman Rd./I'.0. Dox 35'1 City: Lodi, CA Zip;95241-0357 <br /> phone 1: ( Zug ) 368-6175 <br /> Audi n)zcrl hepresentatve of contractor certifying through signature below that the tank has been decontaminated In an approved <br /> manner as requlred by Cal EPA. <br /> Name: +. Tille: « Signature: + Bete <br /> «1«af n#+f.«�S«�}QQ«O�+d l +t+�+pp►+fe+ggat art p+1��+yy+larr0ccar'Gopt vaafpp0lr'Sf Upn0llf( l? 1VQ ryyff 0 f��n t fef rf tel? �ffffff <br /> SF,C'1TON 4 - I'n he signed and plated by an aut6otlzed representatire of file treat fit, atolede, o rdhposa�facll III, <br /> accepting tank and/or piping. <br /> rormiry None: Sclhnitzer SLeel I'rotlucl.s <br /> 17.000 Polson Blvd. Rancho Cordova, CA <br /> Addhess:_ City: Zip: 95742 <br /> Phone /: ( 9 16 ) 985-4810 <br /> Date Tank Received: <br /> Niue _Title: Signature: Date <br /> +N{I+HfaafMN♦N#NfN++♦a►+#+N+►ff►MMfN{a+N►aarN+r#►++►a►M►♦rf♦ff►Nffff ff►ffNfffNff fff Nff� '. <br /> CII 23 046 (Revised 9/11/96) Page 10 <br /> 1, <br /> I <br />