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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SEUVION I - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br /> The Tracking Sheet Is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br /> recycling facility. The permit holder is responsible for ensuring that this form Is completed and returned. <br /> FACILITY NAME: JOLLY JOE'S BAIT & TACKLE EPA Site flCAC 000896616 <br /> FACILITY ADDRESS: 101 W. Charter Way, Stockton, CA <br /> TANK IU #39 - _ Tank Description: 1 - 550 ballon Diesel/ Gasoline Waste Oil <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil Inc. DBA Rich-Mart Construction <br /> Address: 351 N. Beckman Rd./ P.O. Box 35( City: Lodi, CA Zip: 95241-0357 <br /> Phone #: (209 ) 462-4581 Date Tank Removed: <br /> SEcrluN 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil DBA Rich-Mart Construction <br /> Address: 351 N. Beckman Rd./ P.O. Box 35'1 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: ( 2091 462-4581 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated In an <br /> approved manner as required by Cal EPA. <br /> Signature: Title: Vice-President <br /> SF.CI'IUN 4 - To be isiigned and ad�ated by an authorized representative of the treatment, storage, or disposal facility <br /> Tank is free�itf j j�s�udg Xpenfl hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. CIty:Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 1 985-11810 <br /> Date Tank Received: <br /> Signature: Title: <br /> ER 23 049 (Revised 7.10-92) Pelle 10 <br />