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I <br /> SAN JOAQUIN COUNTY PUOLIC IIEALTII SERVICES <br /> 6NVIRONmENTAL IIEALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ++#«+####♦!#♦##!♦4#Mrrr♦NH#rr«♦lffNf#♦♦HH♦♦♦rAlrr♦!!♦fH♦!flrlNffflfrfrrfrgrrr►Ir►►r►►►1►1►►►►►1►►► <br /> 'W(A'ION 1 - Pubtic Ileahh Services F.nvbonmental Ilealth Division Tank Tracking Sheet ahall accompany each lank afflaed <br /> with In site idenuficmlnn number. the 'Tank I'rncking Sheet is to be returned to Public Iiealth Services Environmental Health <br /> Division within JO days of acceptance of the tank by the disposal or recycling facilhy. The penult holder Is responsible for <br /> ensuring that this form Is completed and returned. <br /> PACILI'I'Y NAMR: Fannie Mae Foundation E.P.A. (1 CAC 001314624 <br /> rACILIIV ADDRESS: 25433 Eunice Rd. , Acampo, CA 95220 <br /> TANK ID #39 - TANK SIZE: 350 PREVIOUS TANK CONTENTS: unleaded vaso]ine <br /> .««+a++«+++##+Alrr#+#r+4r!!1♦!rlrr!!!r♦♦frr4#!lffr4#!!fa#f#!♦fffffrl#ff♦r4frfff►r►rr►N►►►►1►,►M►►�*►►?►1►/ <br /> MciION I - to be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe 011, Inc. <br /> Addtess: 351 N. Beckmatr Rd./P.U. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone 1: ( 209 ) 368-61'/5 Dale Tank Removed: <br /> 1+♦!+#«+«♦!####♦♦f4#+♦♦♦lrfflf♦♦♦♦riff♦r!##♦!#4f4#rlfor#r♦f•fr!!•#!!ifff4#♦frffl4rrffrffrfflfrf#f►fff#f♦#fr <br /> SF,C'I ION 3 - To be filled out by contractor "decontaminating tank": <br /> lank Decontmni allon Contractor: Jim Thorpe 011, Inc. <br /> Addtesr._ 351 N. Beckman Ild./P.0. Box 357 City: Lotti, CA ZIp;95241-0357 <br /> Phone T: (--20.9 ) 360-6175 <br /> Audunized lepreacnladve of contractor certifying through signature below that the tank has been decontaminated In an approved <br /> manner as requlred by Cal EPA. <br /> None: Tille: Signature: Due <br /> + «1« + M♦ f♦#r♦# M4 ♦ ♦A !f!♦qf ♦ 44 ##♦f#f ffr#Nf##►#• ###►ff # rr►1q ►► ► ► ►►►►�# ►►1► ►►e►►►� <br /> 1arjFC is Free oFgafF 1payeggyana 1�yAro�aron vators bron d�ef�ver�g�oil4ee�. <br /> SE 'ION 4 - To be sl ned and dated b an sur or ze representative of the treatment, sto e e or <br /> accepting tank and/ar piping. <br /> raciliny Nmne: Schrltzer Steel Pr(mtuct.s <br /> 12000 Folsotn Rlvd. Rancho Cordova, CA <br /> Aridness:_ City: Zip: 95742 <br /> phone I: 19 16 ) 985-48 to <br /> Dile Iank Received: <br /> flame: - _Tide: Signature: Date <br /> ♦+«#«aH#♦###♦H♦H4♦!♦♦rrf 4l+♦♦4f♦rr!#frH+H+HM+«f+.+++++++N+#rH#+++♦f!♦rrfrrif♦rff4rfff4rf♦off#frf <br /> M1 23 046 (Revised 9/11/96) rage 10 <br /> i <br />