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SAN JOAQUIN COUITI'Y PUDLIC iIEALTiI SF_RViCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUNi) STORAGE TANK DiSPOSMON 17RACKING RECORD <br /> .aatat.iii+ttiat+♦+tai+t♦#i#i♦+rii++#♦#+#+ir+tri♦#+ri#lir+#r###♦#rr+♦#♦###########*##*####*##N#+*�**+�*##+*• <br /> STt1'10N I - i'uhlic IleaUh Services Environmentni health Division Tank Tracking Street shall accompany each tank affixed <br /> with It site IrirnllllCnInn mnaher. The Tank Tracking Sheet is to be rennned to Publlc llealth Services Environmental Health <br /> Invision tivhltin.JO.dnvs of arre.ptance of the tank by the disposal or recycling facility. The permit holder Is responsible for <br /> cnsrrring that this form Is cnmpleted and remmed. <br /> FAC11,141 NAMr: Van De Pol Enterprises E.f,A. # CAC002102104 <br /> t'At:tl.ifY nt�i.)RF..SS: 3230 N. West Lane, Stockton, CA 95204 <br /> LANK IU 139 - WANK SIZE: 10,000 904EViOUS TANK CONTENTS: Diesel Fuel <br /> f <br /> ►aaaatiaii+iia+++++ilii+iiMi#ii#♦r#+ri#it+iii#i#rM#♦i�##♦##+#######r#####♦###### ######*###*##�##���*####• <br /> 3FC'I ION l - To be filled out by tank removal contractor: �+ <br /> lank Removal Contractor._ Jim Thorpe, Oil, Inc. <br /> Address: _351 N. Beckman lid./1'.0. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> i lobe rl: ( 209_ ) 368-6 175 Date Tank Removed: <br />.+,siaa.a#a#aaii;iiiii+MtMl+ri+ii#r#i#+♦ii+it♦+♦#if#r#r##♦♦#♦##♦#i##r##1#4#+*##`##�#*####s###**#�*##**AMS###�# <br /> Mf:TION 3 - To he filled otrt by contractor "decontaminating tank": <br /> rank Dernwitninatioo Contractor: Jim Thorpe Oil, Inc. <br /> lddtess:_ 351 14, Beckman ltd./1'.U. Box 35'1 City. Lodi, CA _Zip:95241-0357______-, <br /> hone A: ( 209 ) 368-61'15 <br /> rtthnrizrd representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> anner as rerluired by Cal EPA. <br /> a►ne: � ,¢�,D` /j/Z � Title: �Re�, Signature:Asxrx <br /> a+♦ a,aia #ir:►+# +i# r i# ###wr## + ## ####♦♦ a#r♦#########r###♦♦ # *##♦##♦ #4 * # ###*## A*## #*#+AAAA <br /> f an�C. i s f ree o#ga 1ir 1 urges an �iv rogarbon va ors u�on d( fit vert o c� np t �rli ryet?3. <br /> J-1101"I 4 - i'o he si ned and dated by an ant rorize representative of the treatment, sto age, or s s <br /> accepting tank and/or piping. t <br /> -ility Nnrrre: Schnitzer Steel Pvcxlttcl,s t <br /> 12000 FoIsom Blvd. Ra►tcho Cordova, CA <br /> city: ZIP: 95742 <br /> me /: ( 916 985-/t810 <br /> r- I-ank Recei ed: (' <br /> C <br /> C <br /> re: _Title: Signature: Date <br />•afiattlt+++iii#+# +ii+++i.rii+ir+Mii#rii# +♦i#♦i#++♦tri##+iriir #♦ ## ♦ ♦######r*#########A##+R4#+####♦ •. <br /> ?3 046 (Revised 9/11/96) Page It) <br /> I ; <br />