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t <br /> dare •.i <br /> SAN JOAQUIN COUNTY PUBLIC IIEALTII SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ala#i#!#!4#+•+}#4!#♦ifFsafr+4#lf+ffa4f+4#rrif4r+4+f+ofaff♦f}arff♦f+fffff44ffrfrrr4f14►rrf►r►►►r►►r4►►►rrr►• <br /> SECTION 1 - Public Ilealth Services Environmental lfealth Division Tank Tracking Sheet shall accompany each lank affixed <br /> wilt Its site IdcnNficadon number. The Tank Tracking Sheet is to be returned to Public Ilealth 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 /> eoauring that this form Is completed and returned. <br /> pACILITY NAME: Sun West Liquors E.P.A. l/ CAC 001359464 <br /> 2449 W. Kettlernan Ln. , Lodi, CA 95242 <br /> PACILI'IY ADDRESS: <br /> TANK ID #39 - TANK SIZE: 10,000 ga1s.PREVIOUS TANK CONTENTS: unleaded aaso ine <br /> •«a+alaiiia+a+i+{+lif}f{rr«+fr#Orr+r«af+}f}i♦r}4«4r+{rrff+i+rrr!}rrrfa+++•rf♦ar4rfr►f41#4rfrlf4►4ff►rfgrM <br /> SECTION 2 - To be filled out by lank removal contractor: <br /> Lark Removal Contractor: Jill) 'Thok'pe 011 lrtc <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA zip: 9 524 1-0 357 <br /> Phone #: ( 209 ) 368-6175 Date Tank Removed: <br /> iii+++iii+ail+«iafi}+++4++fr}#aa+a+fff}4f#r+4fffrr++ff#ff4fff+ffffaf4rrffflfr4ffrr4r►frf4►rr4rr444f4444faf4 <br /> SF,CTION 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: Lotti, CA Zip:95241-0357 <br /> phone 1: ( '209 ) 368-6175 <br /> Anthotived teptesentative of contractor certifying ibrough signauue below that the tank has been decontaminated in an approved <br /> rmmmner as required by Cal EPA. <br /> Nance: Title: Signature: ♦ * Date <br /> `1`a#n*K is`free `o#+aY�a�l+u"ages ari8ali#'a"rroccarD011 vafafppor+supondeliveryy#` o `��r 4f"er` 4►4`lOrr►r4► <br /> SF,C'I ION 4 - To be signed and dated by an aulfioNaed representative of the treatment, stolage, or�Tdi;plaaf Feil tyQe <br /> accepting lank and/or piping. <br /> racility Name: Schnitzer Steel I'mxlucts <br /> 12000 Folsom Blvd. Rancho Cordova, CA <br /> Address: City: Zlp; 95742 <br /> Phone 916 ) 985-4810 <br /> Dote Tank Received: <br /> Mame: _Title: Signature: Date <br /> lH«aaH{li raaiaH{4{}p##Nfa+r}arM4if ratrax++a 4if 4f4grf r{4ff#}lfHMff rflf Mf♦44+}{4+aN4}#ra++}f#4r♦ <br /> PH 21 016 (Revised 9/11/96) Page 10 <br /> I <br /> i <br />