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SAN JUA.(UIN COUNI-Y PUOI,IC IIF,ALTTI SFRVIlWS <br /> ENVIRONMENTAL IIEALTII DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •II MMlf H fff r+f♦H HNrif Hi♦♦!+M♦NwiMH fNlN4+f H♦N♦♦fiN!!♦♦i4f!##►M►#►##►►f►ff►ffffffMfffffflfff <br /> SECTION 1 - Public Health Services Fnvhonmrntal llealt, Division Tank Tracking Sheet shall accompany each lank affixed <br /> will, Its site Identiflcmlon number. lite Tank 'Tracking Shect Is m be rejoined to Public Ilealth Services Environments) Health <br /> Diviono whM„30 dare of acceptance of die tank by the disposal or recycling facility. The permit holder Is responsible for <br /> ensmbng that this form Is completed and reuoned. <br /> Rnill 's Car Wash G.t',A, /7 CAC 001481312 <br /> FACILITY NAMI,. Y '- _ <br /> FACILITY ADDRESS: 100 E. nodi Ave. , Lodi, CA 95240 <br /> TANK IU /39 . TANK SIZE:/0 o 4 O PREVIOUS TANK CONTENTS: <br /> Unleaded C-asoline <br /> 11.1•Ia•Ia♦rwori++rw+rrfi++Irffrf!lww+ralrlw!}iwfflflflilrrf!!!!♦ff+rfff+ff#♦!fi►/#►#►►►►►►iflff►f#f►fffflf <br /> SE(:'IlUN I - To be filled out by lank removal contractor: <br /> Tank Removal Contractor: Jlnt 'Pitot' a 011 All" <br /> Address:_. 35_ N. Beckman Nd./P.U. Box 357 City: Lod11 CA zip: 95241-0357 <br /> Phone /: ( 2UQ_) 368-6 L75 Date Tank Removed: <br /> ♦IlwaaH Ma�wa Hwf rf MwfNNwNfwwfaNnlMrfaMwwwwlf wrrf aaN!!♦♦++lf#f!#fH#►♦#f1#+�►►►#fff►►f fffflf#f►ff <br /> SECT ION 3 - To he filled out by contractor "decontaminating lank": <br /> lank Decmumnh,alitnt Contractor: J).m lliorpe Ullj Inc. <br /> Adthess: 351 N. Beckman Rd./P.0, (lox 357 City: Lodlj CA zip:95241-0357 <br /> ['finite 1: 120_9 ) 368-6175 <br /> Audunizrd ieptrsculallve of contractor certifying through signature below that the tank has been decontaminated In an approved <br /> rammer as retlulred by Cal EPA. <br /> Ntnue: 1'Ide: Signature: Dale <br /> • a+1 1 •f1 ftlH♦ Hf ♦ f+ iNM♦! + ♦! +f♦♦1♦ a+♦♦♦1H♦11#f+ffi}f ♦ f#ifN 1► ► / fff►►f f#►f fff fff► <br /> lapk 'is free of aI ��U V s art( IVy(lrfoccarf)on vapors apon diet verV, to *?i* �t gr iteei . <br /> SF,C'INJN 4 - 1'o be signed and date an amtftorized representative offhe treatment, stotage, or spw aril ty <br /> accepting tank and/or piping. <br /> Finality Name: Schnitzer Steel Prcxluct.s <br /> Rancho Cordova, CA <br /> Address!--- 12000 Colson 111vd, City: Zip: 95742 <br /> Phone /: (9 16 ) 965-4U to <br /> Date Tank Received: <br /> Nance: _ _Title: Signature: Date <br /> //•Ha H Hf H#♦f r!♦IN♦w++l+f wf Mff iii+♦♦♦Nrf rf flies♦!H+lflf!!lf qf♦♦M#1f#►►#if#►►f►►►►►f►ffi♦#Mf fiff4 <br /> Ell 23 046 (Revised 9/11/96) Page 10 <br /> I <br /> I <br />