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r SAN JUA(•IN COIJNI'Y PUBLIC HEALTH 3ERVI( S <br /> F.NVIItONMENrAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> a«•}•}r«r}}aa#}}aa}}♦«}r##aa+#+1##a#+tat##a#a#+###+a#f+#f#♦f+♦#########f###+++#4#f#+ff#rrr+rrrlr►►r►►►r►►!! <br /> SEC PION i - Public IlealUr Services Environmental IlealUr Division Tank Tracking Sheet shall accompany each lank &Mxed <br /> wbil tts site Identlfiratoo number. the Tank "1'racking Shed Is to be returned to Public Health Services Environmental Health <br /> Invision }vllhiq 30 (lave of acceptanr-e of the tank by the disposal or recycling facility. The permit holder Is responsible for <br /> emsuhing that 11111 form Is completed and returned. <br /> t <br /> FAC11.1I Y NAM11: Connell Motor Truck Co , Inc E.P.A. 1/ CAD 981682362 <br /> FACILITY ADDRESS: 2211 N. Wilson Way, Stockton. CA 95205 <br /> TAPIY, ID 119 - _/ ov TANK SIZE: 10,000 gal. PREVIOUS TANK CONTENTS: unleaded gasoline <br /> r•rr•r••r}a#aaa«}+ossa«###+aa#a#+r#}#«#a«+##a#♦###«#�#+a+♦a#####a##+oar#+#+####++f+###+rr►frrlr►ffr►►+lr►+r <br /> SFC'I ION 2 - to be filled out by tank removal contractor: <br /> lank Removal Contractor:_ Jim Thorpe 0111 ltrc. <br /> Address:__ 311 N. Beckman Rd./P.O. Box 357 City: (L�odiI CA Zip: 95241-0357 <br /> Phone N: ( 209 __) 368- 5 Dale Tank Removed: <br /> Par•..r•rraaa+•a♦}}«rr#•##«+#«a#}}#+«+♦«###r#aa+aaa#####+++#+++##+++#�4#r1+r#!#+#a+laf+++##+##!+##+##+f#+ <br /> SFI:'l ION 3 - 'ro be filled out by contractor "deconlandnnling lank": <br /> Tank Decontmnluatloo Contractor: Jim Thorpe 011, inc. <br /> Adilmm 351 N. Beckman Ild./I'.0. Box 35'7 City: Lodi, CA Zip:95241-0357 <br /> Phone 1: ( 209 ) 368-6175 <br /> Authottzrd tryhtesenratve of contractor certifying through signature below that the lank has been decontaminated In an approved <br /> manner ns regnired by Cal EPA. <br /> flame: Richard Thorpe Title: Pres. Signature: ¢� 6/10/98 <br /> • •+# •+• #a«# f }#+ + #+ #+!#+++ # #+ +##r#+ ##++4+f###tri+#+++♦ # ##+1111#rr�+r+##+�a+.s.#f♦t►+►r►►4 <br /> lanka 1s free }of ai`f luudyes and 1�ydroCCarGoil vap�ors aDon d"everyy <br /> SEC TION 4 - To be signed and doled by an mulrtorired representative of toe treatment, stolage,of disposal facility <br /> ncreptng lank and/or piping. <br /> r <br /> Facility (Janne West Coast Equipment <br /> Address: P.O. Box2368 City: Turlock Zip 95381 <br /> Phone �: 888 ) 156-8365 <br /> Bare Tank celved: <br /> Nanhc: 1 l'ttle: jam Signature - Date //- 9� <br /> «r•• a#}+a}#«#a#a}#}#}}«aa+##+«}+#a}r++#«r#+}######++4++##faa+##+#+##a++#+##+++####+r###+++rrrfr#+r!lrf+► <br /> MI 23 046 (Revised 9/11/96) Page 10 <br /> I <br /> J <br />