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SAN JOAQUIN COUNTY PUDLIC HEALTH SERVICES <br /> ENVIRONMENPAL IIF,ALTII DIVISION <br /> UNDF,RGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> !««#aa!{+#+rrr++f+++♦l++arrrrrra#♦ar#♦r#a##+rrr4r++♦roar♦rrrf+♦fir#ifff4fffrr4fr4rr4rrf►rr►rfM►►►err*fro►► <br /> SECTION t - Puhlic lfealdr Services Envhonntental Ileallh Division Tank Tracking Sheet shall accompany each lank affixed <br /> Willi hs life identilkmton number. live Tank Tracking Sheet is to be returned to Public Ileallh Services Environmental Health <br /> Divisbnr within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring Ihnt tills form Is completed and returned. <br /> PACIL,LI'Y NAME: Connell Motor Truck Co. , Inc GPA It CAD 981682362 <br /> I°ACII.IIY AOhRRSS: -X2/211 N. Wilson Way, Stockton, CA 95205 <br /> TANK ID #39 - /-30c <br /> o / Q�'ANK SIZE: 10,000 gal. PREVIOUS TANK CONTENTS: diesel fuel <br /> 1••♦a•♦•i+oar««++r#«+r4raa!lrr4a{r!#r#++sail(+sills+#♦r#Orr#frr4af4ffrrr+ffffrifrfMfrfrrrrrrrfrrrr►r4frrrr <br /> sm ilON I - 'fo be filled ont by tank removal contr actor: <br /> Tank Removal Contractor._ Jim_l'Itorve oil. Inc. <br /> Address: 351 N. Beckman lid./P.U. Box 391 City: Lodi, CA zip: 95241-0357 <br /> Phone U ( 209 )- 368-61/$ Dale Tank Removed: / 1 _ <br /> !as•++air+a4«+aa{{«++}+!##4+lr+rr#soar#r♦♦r#rr###4aarr+frrrrrla#f+lr4#ff#4fr4fff44r♦►[•ffr►r4►ffrrrrrrff►rf4 <br /> SR(:'I'ION J - To be filled Out by conlraclor "decontaminaling lank": <br /> Inok Uecomaminatlot, Contractor; Jim Thorpe Mir Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA zip:95241-0357 <br /> Phone a: ( 209 ) 366-6115 _ <br /> Anrhodznl rrpresrnlative of cmnractor certifying through signature below that the inok has been decontaminated In an approved <br /> manner is rennired by Cal EPA. <br /> Name: Richard Thorpe Title: Pres. Signature: 6/10/98 <br /> • «## ah•+a r{r#+f +a4 + #+ #fir+fr r +# f#+af♦ a4rf4rr##rf!l44ffrr f 44ffffl►f++4+a+++++++++41rHrrrrrr <br /> lan�( 1S free n# afT §1 dyes ant 1iydpocc,,-aroon vators apon �et�veryy <br /> SEC'1ION 4 - 1'o be elgned and dared by an aut tot zed represenla�ire of the treatment, sldfage, or disp6sal laclllty <br /> accepting tank and/or piping. <br /> ,,.fillyI4mne: West Coast Fkuiprnent <br /> Address P.O. Box2368 Clly: Turlock Zip 95381 <br /> !'hone J: ( P.S8 _) 396—(8;265 <br /> Dote Tank Received:__(Q <br /> Name:-c-—)62 _ Tide:-� Signarur <br />!+«+a+f{!4{4r++{4#r+r++r#r+4f++#+rr++i+r44##+rr+#+++rfrrr4ff +f44r4r ffflfrrff rrfrlfrr4►f/rrrr4frrffrrf <br /> FII 2.1046 (Revised 9/11/96) Page 10 <br /> 1 <br />