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N.. " <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />I - P++l##+I4aa144♦+!4!#!#t44144i1#4#!i#a##a##4r#4f1#If44Y4t/!#YI#!•44Y41f#141#ff4fff•ffffffffMff►fff4fffflffff <br />SRC'fION ublic Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br />with its site identification number. the Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br />Division within JO days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br />ensuring that this form is completed and returned. <br />FACILrrY <br />FACILITY ADDR <br />TANK ID N39 - <br />Henry Hansen Property <br />G.P.A. A CAC 001463568 <br />200 S. Cherokee Lane, Lodi, CA 95240 <br />TANK SIZE: <br />350 gallorftEVIOUS TANK CONTENTS: Waste Oil <br />###########44##!##+#411►4441##i144/###Y###41#Iart4t#4##111#11411#i#♦#♦f#f4#flf1Yf41f1ffffff141!fU►ffffffff►If <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thorpe Oil <br />Inc. <br />Address: 351 N Beckman Rd./P.O. Box <br />357 <br />City: Lodi r CA <br />Zip: 95241-0357 <br />Phone N: ( 209 ) 368-6175 Date Tank Removed: <br />#+#########!############f#!lllaiif###lf11##fi!#!++##YY4#t1#alai!#af1f11####!•####4fffyff##ff1#f14#f#f♦f#### <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br />Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br />Phone N: ( 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: <br />Title: <br />+Tank' is+f'ree'o 'a'udg'e's"an <br />SECTION 4 - To be signed and dated by an <br />accepting tank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />Address: 12000 Folsom Blvd. <br />Phone N: ( 916 ) 985-4810 <br />Date Tank Received: <br />Name: <br />Signature: Date <br />Raucho Cordova, CA <br />City: Zip: 95742 <br />Title: Signature: Date <br />+++f##+#++#a#####!Y###♦#4a+la#!t+#a!!a+##4##Ya1##1##atir#41#1+44#art#4114/♦YfffYYf#rNfffN#Mfflfffflirtff <br />Ell 23 046 (Revised 9/11/96) Page 10 <br />