Laserfiche WebLink
SAN J0AQUIN COIINI'Y runuc DEALTit SF.RVitfS <br /> ENVIRONMENTAL IIEALTII DIVISION <br /> UNDERGROUND S'T'ORAGE TANK DISPOSITION TRACKING RECORD <br /> «««!««1lf4fffflfa♦+a+f#►#+►a4fA+♦♦f►#►1f#►4f4#a►14►+►1aF###+a444alf1444#•fff44ffffffffffflM4N1f*ff.ffffff <br /> SFC'I ION I - Public Health Services Fnvhonmrntsl llealtt Division Tank Tracking Sheet shall accompany each bank atlbted <br /> with Its sitr I tnnillcadnn number. The 'Tank l'racking Sheet is to be renamed in Public lleallh Services Fnvlronn"1911 Health <br /> bivislon nUbbi-30"Misys of screptnnce of the tank by the disposal or recycling facility. The permit holder Is responsible for <br /> rasming that this form Is completed and retuned. <br /> I'ACILI'IY NAME: Sum West Liquors_ E.P.A. n CAC 001359464 <br /> 2449 W. Kettleman Ln. , Lodi, CA 95242 <br /> 17ACIVITY AIMPFSS: <br /> TANK hb J39 - TANK SIZE: 10,000 gals.pREvIOUS TANK CONTENTS: unleaded g co ince <br /> r«««a 1««111«««ffff««ff++Gaff+#«#####a+a+ffff♦f1#f+44�##4+►4#41##rf#a1►#♦F►►+++#f4f►►44ff444f�fffflf.ffff44f <br /> SEI;IlON 1 - to be filled out by lank removal contractor: <br /> lank Removal Contractor: Jim 11101-M 011 ltic - <br /> Addhess:_ 35_1 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone 1: ( 209_) 368-6 I.15 Date Tank Removed: <br /> «Ha«H!M«f!!!f♦++HlN►r+4f4f#!!Mlfi4l+MN1#4H4N#►af4♦M►f4444Mfff}f4ff444ffff�ff4ffff44f 44►►4444((4 <br /> SFCI'ION 3 - To be filled out by contractor "decontaminating lank": <br /> lank Oertomm"hnaton Contractor. Jim Thorpe 011, inc. <br /> Arhbrn: 351 N. Declntan lid./P.O. Box 35'1 City: Lodi, CA ZIp:95241-0357 <br /> Phone A': f 209 ) 360-61'15 <br /> Antunizrd teptesrntatve of contractor certifying though signature below that the tank has been decontaminated in an approved <br /> manner ne te(johed by Cal FPA. <br /> Nnme: Title: Signature: Date ! <br /> «r! « «#« 4♦++f4 f! + ar .44ff►4 « 4f 44.4.4 4#►•►►4##4►4►+►►4## 4} 44.f 4.tf.�Ag n�t for` tee Iff...4f <br /> latik �s tree of aY� �lkdge an81kydro5arbon valrors u�ron dI ver o �I' a�g <br /> ,,rat <br /> EC TUN 4 - 4'o he signed and aled by an aul or ze represents lye of the treatment, slo age, or spos axil ty <br /> accepting tank and/or piping. <br /> rtirliby Nnme: SchniLzet• Steel 111,otluct.s <br /> 12000 Folsutn Blvd. Rancho Cordova, CA <br /> Address: _City: ZIP: 95742 <br /> rhone 1: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> (Intoe; tide: Signature: Date <br /> rf«1«a«+«««+#+««41«11«1w1«111.««1«111++«II+Iw««!w!«w«f«w♦♦«w14«If«a♦4•fIf««+#+♦r!#+4ar►a444a+►r+#+#►+►►►4 <br /> Fit 23 046 (Revised 9/11/90) page 10 <br /> i <br />