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%love ��.. <br />SAN JOAQUIN COUNI'V PUDLIC IIEALTH SERVIC//ES <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND S'T'ORAGE TANK DISPOSITION TRACKING RECORD <br />14 MI#+H # 144 4 #+++*4INN#+1#TNI+►►+♦It Mt#►Hf+♦+►t♦##►#NttIMH+++ftlfN►11N11111111111111111/11111111 <br />SM, I'ION 1 - Public, Ileallh Services F-nvhoomrmnl Deallh Division Tank Tracking Sheet shall accompany each (ank Iffiaed <br />will, Its elle Idnnilic,1don number. I he Tank Tracking Sheet is to be returned to Public Ilealth Services Environments) Health <br />Dlvlzino wllhln_3o_ (lays of arreptance of the Innk by ilia disposal or recycling facility. The permit holder Is re truaibl r for <br />ensuring 111,11 this form Is completed And returned. <br />FACILITY NAME:- Sun West Liquorsli.P.A. n CAC 001359464 <br />2449 W. Kettleman Ln., Lodi, CA 95242 <br />1°ACIIJI Y ADDRESS: <br />TANK ID #39 -Sb 3l,,�—TANK SIM 10,000 gals PREVIOUS TANK CONTENTS: unleaded easol iup <br />1411a 4411.1}444144444!♦}}}}}}♦}}}♦}14#}}44}}!4♦f#!##!#!}!!#f#1♦##111##t##f+1#♦!l+ft1//1►1111111►1111+111111 <br />SE(:f ION 1 - In be (filed out by tank removal contractor: <br />lank Removal Contrarmr: J1111 Thorpe 011 luc <br />Address:_351 N Becknlau Rd./P.O. Box 351 City: Lodi1 CA zip: 95241-0357 <br />Phone /: (2UQ_) 368-6175 Dale Tank Removed: .99 <br />}11114344}I♦4}}/#1#4}}}#►#4#►►#t#t##f}}}}}}}}}!+}}}}}+►/}}}♦►tftt+►♦ t1fl++ffNfllflA'If+►tff►►f►4++Itlfff+ <br />SRC'I IM 3 - To he filled not by contrac(or "decontaminating tank": <br />lank Decontamination Contractor: Jim <br />'Thorpe <br />Oil, Inc. <br />Arldtess: 351 N. Ueclunau Rd./11.0, <br />Box <br />35*1 _City: Lodi, CA <br />ZIp;95241-0357 <br />Plrnne 1: 1 209 _) 368-6175 <br />Antitothrd teptesrnlative of contractor certifying 111rnog11 sigoaune below dial the tank has been decontaminated in an approved <br />manner anrequired by Cal EPA. <br />Name:_ f`1 C.>t.AA Title: _ Signature: v2llite� 0 <br />+17A.kIH ti}#1# }♦} ♦ #t tNK►► } ►# #t+#!# M+fflff+lllfttTT♦• f pwwf• •* + + *+++++ <br />Is free of of p geS an 1tycrroccar)on va)ors ucon a veryy o CC n tzar tee . <br />SM ION A - 1b be signal and dated by an sulRnrized representa�lre of t�a treatment, stolage, or d sposal iK ty <br />accepting tank and/or piping. <br />racllhy Name: SclullLzer SLeel Products <br />12000 Polscxn Rlvd. tlmtcho CoMova, CA <br />Addtesa:_ City: ZIP: 55742 <br />rhmle f: <br />(_916 ) 9U5—/181100 <br />1) le Tank R%eived: / <br />S 9 <br />Man e. _ T1tie: _Slgnanire 2 <i Date 7/c/ <br />1141144}444♦ ♦}#♦ft+lt+t}#f 1}#♦#t♦♦t!♦tN 1!#41#tf fl4♦4.441♦i4H4N44H♦M4}}♦##♦+♦tttttl##ft+N#♦tit+t#f <br />Eli 23 046 (Revised 9111/90) Page ID <br />