Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> asa4##aaarf!#4#ars►rff}}►ria►4►►4r►►►►♦!►frr444►4rrrr44♦afffa►aa►►fl►arr4l►l►rrl►/t►irirf►►it►ttl►•ttt►f►t► <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with Its site Identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder Is responsible for <br /> ensuring that this form Is completed and returned. <br /> FACILrrY NAME: Panella Trucking, Inc. E.P.A. 11 CAL 000057083 <br /> FACILITY ADDRESS: 5000 E. Fremont St. , Stockton, CA 95215 <br /> TANK ID #39 -/JJ3—a / TANK SIZE: 12,000 gal. PREVIOUS TANK CONTENTS: diesel fuel <br /> a++fa+++aalaf44r}+r►•aaraalr+44arrrr44+##4falfrfr#frf!!#}4f•rfrfrrrl►ra#44/rf•►4flr/rtftirl►tft►t►f•IfffrN <br /> SECTION 2 - To be Riled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CSA/ / ,)zip: 95241-0357 <br /> Phone I: ( 209) 368-6175 Date Tank Removed: <br /> a++++i+falrrraf#fr}#rata►!lrf}4}}rrr#rr4l44l4rlflf!♦ff!♦ffr}r}♦a4a}}fffrl44af4frlr!■l►f►►►►fltrf►rri►fii/#► <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br /> Phone N: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated In an approved <br /> manner as required by Cal <br /> EPA. , / �/ <br /> Name: �-(C f n', J M ap{ Title: I/ SignstureAtiti�/� Date <br /> ++++++Ni+#f#ar#!af##}a4MlMlrr}tits!!!#a!!lrrgNNt•M4}!r►f qtr♦rraN►►Nfr►ltlrMfMgiiit►l►ftfffft► <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: West Coast Equipment <br /> i, <br /> Address: P.O, Box 2368 City: Turlock, CA Zip: 95381 <br /> Phone /: ( 888 ) 866-8265 <br /> Date Tankc ved: <br /> Name: Title: Signatur Date — <br /> ##+aa#+aft+4r}++4�r+►+!flr4ra+r4#!}4aF►rfa#4+aalrrffrrf4r}rlr4+4rfa+rfrft•►f►►arlf►rrrfq►flgfrttpriitr <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />