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� v <br /> SAN JOAQUIN COUNTY PU ILIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> «+aaa«aa+ra+aaaarrrar♦♦rraararrr+++r+♦+rrr.l+»aa»lrrrrr!♦rrr+rrar»rrrarrrrrrrrfrfrrrfrrq►f►►Ir111►►►►►r►r► <br /> SMA ION 1 - Public llealth Services Envirnnntenral llealth Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its site Identincadon number. the Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within _30_dovs of acceptance of the tank by the disposal or recycling facility. The permit holder Is responsible for <br /> ensuring that this form Is completed and returned. <br /> FA(7L1'rY NAME: Reilly's Car Wash L.P.A. 111 CAC 001481312 <br /> rACII.I'I'Y ADDRESS: 100 E. Lodi Ave. , Lodi, CA 95240 <br /> TANK ID s'39 - TANK SIZE:/D O PREVIOUS TANK CONTENTS: Unleaded Gasoline <br /> .«+ata+r+«a+•«•+r++++r++a+ar+++rrlr+++r++r++++a»a+lr++la»•+•♦!+»rarrarrrrrrrarrrrfrrrrlrrfrrfrffffll►rrfrrr <br /> SFC'I ION 2 - To be filled out by tank removal contractor: <br /> rank Removal Contractor: Jim Thorpe 011 Inc. <br /> Address: 351 N. Beckman Rd./P.0. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone 1: ( 209 ) 366-6175 Date Tank Removed: <br /> +ar++++++++aaaaar»r«fart+rrr»ra++rrrs++++»!lraa»rrrrrr•rrr»r»rrrr+r♦rrrl+rrrlfr♦4frff#Ifirrfrl4rfrrffff►►r► <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> tank Decontanduatlon Contractor: Jim Thorpe 011, Inc. <br /> Address: 351 N. Beckman Rd./P.0. Box 357 City: Lodi, CA Zip:95241-0357 <br /> Phone /: ( 209 ) 366-6175 <br /> Authorized tepresentadve of contractor certifying through signature below that the tank has been decontaminated to an approved <br /> mm"ner as required by Cal EPA. <br /> Name: Title: Signature: Date <br /> • n is <br /> ree o ++ + ar ges a r a +f r•♦r»! a!r•r!»+rr!»f+•»»r• » frrrff fr f f rMf►1 ►rM Irlff►► <br /> Yank is free of aYf kludges an ltityaro�ar6on vaCors u�on d+efi�ver� to 'r��intgr tee . <br /> SFCITON 4 - To be signed and dated by an ant or ze represents Ire of the treatment, stn age, or epos aciI ty <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Pr(xIUCLS <br /> 12000 Folsom Blvd. Rancho Cordova, CA <br /> Address: City: Zip: 95742 <br /> Phone /: ( 916 ) 965-4810 <br /> Date Tank Received: <br /> Name:_ _Tide: Signature: Dale <br /> +r+tar+a++arrraaarr+lr•r•r++r+++arrarras••ar+rra•ra++rrraa+++++++rrr+ar♦+«r++♦aa•r•r»++•a•+r+rr+r•rr+a•r♦ '. <br /> Ell 23 046 (Revised 9111/96) Page 10 <br /> I <br />