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SAN JOA JUIN COUNTY PUnI.IC 11EAL771 SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •++a•r♦rr♦arr•rrrrrrarrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr+rrrr++ir++r+•lrrrllNlM!!!!!!!1!!!!!!! <br /> SECTION 1 - pnblir IlealUr Services Envhonnnentnt Ilealtn Division Tank Tracking Sheet shall accompany each lank affixed <br /> with Its site idenrification number. the Tank Tracking Sheet Is to be returned to Public Health Services Environmental Health <br /> 1110floo within 30-darn of acrrptnnce of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensoning that this form is ennrpleted and returned. <br /> PACILIIV NAME:_ Sun West Liquors_ E.P.A. n CAC 001359464 <br /> 2449 W. Kettlernan in. , Lodi, CA 95242 <br /> fAC1I.IIY ADDRESS: <br /> TANK ID #39 - TANK SIZE: 10,000 gals.pREVIOUS TANK CONTENTS: unleaded gasoline_. <br /> .a++•+aa+++ra+a++rr••+r+++rarrrrrr+++♦rrvr•a+r♦r•PPPPPP•rarrrrrr•♦Phar+rrrrrrrrHrrr►Ntrr+r�r!l+rrrlMrrrr <br /> i;vC'IIUN 2 - 10 be filled out by tank removal contractor: <br /> lank Removal Contractor: Jlat '1'hot'pe 011, 111C <br /> Address: 351 N. Beckntau Nd./P.0. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone /: (_2UQ_) 368-6 175 Date Tank Removed: <br /> ♦+.+aa+a+rar+rr a••r+r+ra+++rrraarrrrrrrrrrr+rrrrr+rrrr+rrrrrtrrr++rrr►rr++++r+++r++r++rl++rrrrr!++rrrrrrrrr <br /> SECTION 3 - To he filled out by contractor "decanlaminaling lank": <br /> lank Decontamination Contractor. Jlru Thorpe 011, Inc. <br /> Addrrss: .351 U. Beckman Rd./P.O. Box 35'1 City: Lodi, CA Zip:95241-0357 <br /> Phone /: ( 209 ) 368-6175 — <br /> Amhntbed rrprrsentative of contractor certifying through signature below dint die hank has been decontaminated In an approved <br /> manner as requlred by Cal EPA. <br /> Name: 1'Ide: Signature: Date <br /> + +++ + +r+ rrr+++ raw • ar rrrr•►♦ a rr PPPPPP aarrrrrrrrrrrrrrra+ r rrrrr+ rr r ! rrr!!r rrrr !!!!!!r <br /> larj�C is free of a(C ludye$ ana l�yrlro�anon valrors apnn defi�ver� �o � �inIt fr �teefi. <br /> SEC TON 4 - to he signed and dated by an au( or ze represents Ire of tfie treatment, sto age, or epos acll <br /> accepting tank and/or piping. <br /> facility Name: SclmtlLzer SLeel ProrlucLs <br /> y <br /> 12000 Flsoin BlvdCi : Cordova, CA <br /> Addrno . <br /> a: City: Zip: 95742 <br /> phone /: (_9 16 ) 985-48 10 <br /> Date Tank Received: <br /> Name: __ "lite:_ _ Signature: Date <br /> +++++++•+carr•++rrrr•♦a•rasa+aaaaaaa+sass•♦aaa+wawa+aa.rr+aa♦aa♦♦++aa•++•rrrrrrrrwrrrrrrrrrrrlrrrrrlrrrr . <br /> fill 23 046 (Revised 9/11/90) Page 10 <br /> I <br /> 1 <br />