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SAN Joja4ULN COUNTY PLBLIC HEALTH SERV,�S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSMON TRACKING RECORD <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> [his form is completed and returned. <br /> FACILITY NAM—: Central California Traction Company EPA „ CAC 002106440 <br /> FACILITY ADDRESS: 1645 Cherokee Rd. , Stockton, CA 95205 <br /> TANK ID. 39 - � TANK SIZE: PREVIOUS TANK CONTENTS: 0411 r� <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil, Inc. <br /> Address: P.O. Box 357 Ciry: Lodi, CA Zip. 95241-0357 <br /> Phone #: (_2 09 ) 368-6175 Date Tank Removed: <br /> }#z################i!i#Y:#rtii###»############r##i#iiYYYi####}#i!###z#######i##Y#!####»zY}!!rtz######»####a## <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 Ciry: Lodi , CA Zip: 95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: Title: Contractor Signature: Date <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment. storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address:12000 Folsom Blvd. City: Rancho CordoVp; CA 95742 <br /> Phone #: ( 916) 985-4810 <br /> Date Tank Received: <br /> Name: Title: Signature: Date_ <br /> ##»izi#iaai.Y#z####1iii###Y}}##}:izi##Y##!#»i!##}i#i#####!#i#i####az###AYi##Yii»i#}alYili##r#ii#}##i#»#»# <br /> EH 23 046 (Revised 10/19198) Page 10 <br />