Laserfiche WebLink
i <br /> I , <br /> i <br /> UNDERGROUND S'T'ORAGE TANK DISPOSITION TRACKING RECORD <br /> r1►#►r►r►►0444►rl►#rN 4►►►►►#►►►►4►4►s•►r#►#r#►►N r►►#►►#►►►N►►►►►►►►►##4►►##►►►►►►►►rr►#r►###rir#404#4##♦ <br /> SECTION I; - Public Health Services Tracking Sheet will accompany each tank affixed with Its site identification number. <br /> Ila Tracking Sheet is to be returnee! to Public Health Services Milli 30 duys of acceptance of lite lank by the disposal or <br /> recycling facility. The permit holder is responsible for ensuring that.this form Is completed and returned. <br /> FACILITY NAME: Van De Poi Enterprises <br /> I <br /> 3 FACILI'T'Y ADDR�2_4� —Pacific Ave Stockton CA 95204 <br /> 10,000 gallon ?%IJ <br /> TANK ID #39 - Z —O Z Tank Description: <br /> lrr4r0r0l0004000444►�!!�►!#►000444000►lss040#!0!##0#4s►r!#►###►#►rrr►►►►►►!!!!►►#sr#►s0s•s0s00l0►0s#ss0#s#r <br /> SECTION 2 -To be filled out by lank removal contractor: <br /> r Tank Removal Contractor, JIM THORPE OIL INC, <br /> i <br /> Address: 351 N.- BECKMAN RD, / P.O. BOX_357 Chy�:: , LODI ZIP:" 52 <br /> 941-0357 <br /> i Phone #: 20( 9 )_ 368-6175 Date Tank Removed:T/� i1�r � / <br /> r##r►r►rrr#�#►r#004040###►r►#-#N►••0r►rrr►►►r#rrr##N###•N►###•##►#rr###i###rr#!#r#r#rr#r►►Nr#►#!#r►#♦### , <br /> SECTION 3 -To be filled out by contractor 'decontaminating lank": <br /> Tank Decontamination Contractor: JIM TIIORPE OIL. INC. _. <br /> Address: P;0. BOX 351" City: [,,OD) Zip:__95x41-11357 <br /> i <br /> 1 Phone #: (202 �_ 368-6175 _ <br /> Authorized represenidtive of contractor certifying through signature below that lite tank has been decontaminated In an <br /> approved manner as r wired b EPA. <br /> 1 Signature: Title: " U/Cel PRESIDENT <br /> ,i t#1400, 00 0 !04!04 !4.444 000 l400r jy <br /> •ss0�anp areree�4 � slue a�d hydrcr�o�t vauo ` '�i ' � � � zer SteelSI,CfION - e signed and dot y an outite representative a the r titer nr s <br /> accepting lank and/or piping. <br /> Facility Name: Schnitzer.Steel Products <br /> i <br /> Address: 12000 Folsom Blvd. city: Rancho Cordova Zip: 25742 <br /> ' Phone #: 916 985-4010 <br /> I <br /> � Date Tank Receiye c <br /> Ii <br /> i Signature: Title: <br /> 1 <br /> l4r404e040400004444 rs44 00#4#!lsi4►►►#►r0ssrrsisr0#!##4#1rrr#rrs#s4rr##00lsr►►r►#►r►rs######s#4rlslrr <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />