Laserfiche WebLink
SAN JOAQUIN COIINI-Y I Vnt,iC IMALTII SERVICL3 <br /> ENViRONA1EK'rAL IMALTII DIVISION <br /> UNDF;RGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> .aaaaa+++++♦a++++++aa♦♦++a+a++a♦aa++++++++++a•++«+«+«+•«+«}}+++«+++♦r}}}}i!N♦!!!!r!#####M!!!!!*#4!!#!!#�** <br /> !lPt�-r141 IN I P1 11111r. I le-11tlr •lel vicr.i rnvi,r,nmenrni 11r-11111 Division'Tank TrackirtR Sheet !hail accompany each (Ank afQ7ted <br /> kvith iti lite idrntific rano nnnlher. Ilie Wank 1'rarkh►R Shret is at be retatneri to Public Health Services Environmental !Health <br /> itivisinn n10111130 days of arrr•ptartre of the tank by lite disposal or recycling facility. The permit holder Is responsible for <br /> cr►snrhtg that t11i. for►n 1.1 completed anrf ferruled. <br /> PACII.TTY NAM P- Van De Pol Enterprises I/ CAC002102104 <br /> I'A(:1I.11Y AD01117S1: 3230 N. West Lane, Stockton , CA 95204 <br /> TANK 11) 139 - 1 2?2 TANK SIZE: 9PAEVIOUS TANK CONTENTS: Gasoline <br /> ZZ L <br /> ►.aaaaa.♦aa+aa+++a+aaa++++++a•+aa++++++++++aa+++«++tf++a}+++}}+++++}rr}}}}ii}!rt#!######!##!M♦ #!#*!#!+!�* <br /> .911,1A WN I • In be filled out by lank temovai confracfor: <br /> lank Removal Contractor:_ Jlm •I•l1ot-V(_- Ull, 1110. <br /> A ►dtrss: J j N, tleclunatt lid./P.U. Uux_JW City: Lodi, Cal Zip: 952 ►i-0351 <br /> I'hnne 1: f...209—) J68-6175 Date Tank Removed: 4—e,601-�• � t�Tei <br /> 1a.a♦aa.►+.+a+++++a as as a++a++aaaaa++++•a+••a•aa+a♦aa+«a«+++ata+*a+++++ii}##rrir!!.#r#r###!!!!!###*#4######! <br />-W-1101`4 .1 - 'To he titled not( by contractor "decentaminatfnil lank": <br /> imik i)ccnnts►minario►t Contractnr: JLtn Thorpe 011, Inc. <br /> Adeliew J51 14. Oeciunatl ild./P.(1. Box 35.1 (-fly.. I,od1j CA 71p.95241-0357 <br /> Plinrte a: ( 209 ) J68-6175 <br /> imilntirrri trl,tr-.,rntative of cot►tractor certifying through signature below that the tank has been decontaminated In m approved <br /> tanner as rcrinfred by Cal PPA. <br /> —}- <br /> Anrp Jkp/L�,e title:_ �� Signature- <br /> .0 <br /> ignature: to <br /> +++ r•aa+ .+«++♦ +a+ . ++ riiaair + �►♦ ii+.ii }i#}}}i+iiiii+•ir«r i #!i#r! #! f ! !�►*!�! •##! !!*�!!• <br /> 1 a►i�C i s Free o1 a�f1 tlgpg arc 1 t1 o4�r�a►1 vatrorS a mn c�e t�veroC�jn tieree�. <br /> C;t;1 ION 4 - To he signal ami riaterf !ty an aulfrnrized repreientatt.e of tl�e treatment. stoi ager or dfsposa! racilit <br /> arceptlntt innk and/or piping. <br /> SclmI.l.zet- Seel Protlucl.s <br /> trillty ilntnr.:-.--�---` <br /> 12000 Folsom filed. iaticho Cordova, CA <br /> (11Y. Zip: 95742 <br /> 916-_)-9135-4810 <br /> re Tank Rrceived: <br /> D�s�1� Swt�i�Signal Date Z 2fp �n <br /> aaw+a++a+++++a++++++a•a+aa«a+++•+++++a+aaaaa+•+«•+a+aaa+•++a+♦•+«+a++««w++..}}«r«rrlri!*!!##r#r#!i!#!# .. <br /> 23 040 (Revised 9111/96) Page 10 <br />