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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC2:� <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />as+ya. a.aa+.a♦arw+r+rra+ffiwrwrrr.+wrartlrfirrwwtwrfrslfwrwrrlrwlffiMlf!♦!!lfif•fwfffffff!####fN##f#ffffff## <br />SECTION I - Public 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 30 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 />FACILITY NAME: Ro–Tile <br />E.P.A. (f CAC 001381616 <br />FACILITY ADDRESS: 310 N. Cluff Ave. Lodi CA 95240 <br />TANK ID N39 - TANK SIZE: 500 eal . PREVIOUS TANK CONTENTS: di e - 1—f Le- <br />aar++aa+++rrarrawrrr##ar#rlr+rrrrrrs#rl+fr#rf+t#rr+rr#l+srfiflflrflt#tf+rrfif!#r!#r!!fl+l++#++lf+ff+lwf/llrrr <br />SF,CTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thor2e Oil I Inc. <br />Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone #: ( 209 368-6175 Date Tank Removed: <br />++..a•.aa#.aa.rfiffrarl+wfi+#rrrir+w#rff!#.ryir#wiwri.rrffrf!•tris#fi!!fi!#fi!#fi!#♦fr#rfflf►f#f###!flfflf♦##ff <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 Zjp:95241-0357 <br />Phone s: ( 209 ) 368-61 <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 />Facility <br />Address: <br />Title: Signature: <br />Tree OT ati stuoyes tut <br />4 - To be signed and dated by an <br />accepting tank and/or piping. <br />Schnitzer Steel Products <br />12000 Folsom Blvd. <br />Phone R: ( 916 1 985-4810 <br />Date Tank <br />of <br />Rancho Cordova, CA <br />City: <br />Date <br />Zip: 95742 <br />Nance: Title: Signature: Date <br />a....... .rt ... r ... rrr.#r+..rtr.a..tt.r+w....w.rt+.r.rrw.rt#.rr:.wrrrrlrrwrwrrrlfilwrwwrrlfrrrffilfrrrrfrrwr <br />Ell 21046 (Revised 9/11/96) Page 10 <br />