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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD
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<br /> SECTION 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: Don Rodgers
<br /> FACILITY ADDRE,4500 W. Charter Way, Stockton, CA 95206
<br /> TANK ID #39 - Tank Description: 550 gallon gasoline
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<br /> SECTION 2 - To be filled out by tank removal contractor:
<br /> Tank Removal Contractor: JIM TH08PE OIL INC.
<br /> Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODI, Zip: 95241-0357
<br /> Phone #: (209 368-6175 Date Tank Removed:
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<br /> SECTION 3 - To be filled out by contractor "decontaminating tank":
<br /> Tank Decontamination Contractor: JIM THORPE OIL INC.
<br /> Address:—P.O. BOX 357 City: C.ODT Zip: 95241-0-157
<br /> Phone #: (209 ) 368-6175
<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: PRESIDENT
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<br /> Yank p1p1n� arae tree qT �T1 slud�es a�1d h0roc rbop vapors u�o c�eg�i�� p�� It,, zer Steel .
<br /> SECTION 4 - To a signed and dale by an an rorize rep esentat�ve 0 the reatme or s aIS1SW
<br /> accepting tank and/or piping.
<br /> Facility Name: Schnitzer Steel Products
<br /> Address: 12000 Folsom Blvd. city: Rancho Cordova Zip: 95742
<br /> Phone #: 9( 16 ) 985-4810
<br /> Date Tank Received:
<br /> Signature: Title:
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<br /> ER 23 049 (Revised 7-10-92) Page 10
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