Laserfiche WebLink
+r <br /> I <br /> I <br /> UNDERGROUND S'TMAGE TANK DISPOSITION TRACKING RECORD <br /> •,�rsr1##r#rr#rrrr#+s#rrsssrrrrrr##r#rrssrrrrrrrrsrrrr#resrrrrssrssssrrrrrsss*rrrrrr#r►#r#r1###arrr#1##r1#r# <br /> $ti'U110N l - Public health Services Tracking Sheet will accompany each lank affixed with Its aIle identification number. <br /> The Tracking Sheet is to be returned to Public health ServicesyrlWJn 30 Ogg of acceptance of the lank by the disposal or <br /> recycling facility., The permit holder is responsible for ensuring that this form Is completed and returned, <br /> ErACILITY NAME: Van De Poi Enterprises <br /> y laACILWY ADDitE ;924—pacific Ave Stockton CA 95204 <br /> ` <br /> TANK ID #34 - ,� Z/ti -•-� C2310,000 gallon e-5 <br /> Tank Description: _ �! <br /> /4.0040to/4.1/r##'4.r##944.4.#rOtt er/##rrrrrifrss;r#rrrr*roert*r4*ssiarsrrrr0rrrrssrrrrrrrrrrtoo r#4.r/0rss#*r 46049 <br /> fl! SECUON 2 - To be filled out by tank removal contractor: <br /> I 'Tank Removal Conlractor: JIM THORPE OIL, INC. <br /> Address: 351 N. BECKMAN IID. / P.O. BOX 357 City: LODI, zip 95241-Q351 <br /> r Picone #: (_209 368-6125 Date Tank Removed:_ <br /> •*•s*rr***s*s***s**rrrr***�reser***r*rsrsr*rrrr*rrrrr:*+s*s*r►*rsrsr**r*ss*****sr*:**:*rrrr**r*rrrrsr*4.4.4.4.4. <br /> f9rCI'ION 3 - 'lir be filled out by contractor "deconramineting tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL, INC, <br /> Address: P.O. BOX 357 City: LOUT Zip:_Q5241-11351 <br /> j <br /> i Phone #: { 209 ) 368-6175 <br /> Authorized represenlalive of contractor certifying through signature below that. (lie lank has been decontaminaled In an <br /> Rpproved manner as r tired Ca <br /> Signature: 'Title;G%Ci� PIiE.SInfNT - <br />,1 r# #•A04 • q#rrrr# 4.r*rspl or* *ase* *' rrr**s**syslrrs*r•t***rr*►r*rrrr**rtr�#�rA*#*r**#rr##*r�#rrf*ri*r1*#*##* <br /> if <br /> �[ , C 4 p� bore <br /> a gn edea nl d ill y iia l orize�repr'�s ll a ve oil na�io �1���lYsprl�al �zer St @81 <br /> accepting tank and/or plying. <br /> l:acillty Name: Schnitzer-Steel Products <br /> l Address: 12000 Folsom Blvd. City: Rancho Cordo a Zip: 9574 <br />` Phone #: 9( 16 ) k 985-4810 <br /> I <br /> I Date Tank Recelyed, <br /> Signature: Title: <br /> ER 23 049 (Revised 7-10-92) Aeye 10 <br />