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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •V•aaatlfat•tttlrfff•t•••ft•f•ffff•,V,•tf1a,,,!••••tarfff•f t••••••t,tit!••f•f i••f,••••t♦tlftii•atttffrtf•ti <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: J.H. Simpson Company EPA #CAC 001189064 <br /> FACILITY ADDRESS: 4025 Coronado, Stockton, CA 95204 <br /> TANK ID #39 - Tank Description: 2,000 gallon ul gas <br /> •r•f♦rtt,•a•f••••!•air!••fa,«uaa,•„«f•f raa•!a•,a•,!•ff ultua•ulf rf!•arta!•••t♦••rflr•f rt!l Nit•tfffu!• <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE 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: <br /> ..,,,,•••ff,f,f••••,f,•••••fr,••,••rff•af•,••a•,•,••••f,f,•••,rf,•,••••a•,ff•••ff„•••f•,•••fff,f•••f,•.... <br /> SECTION 3 - To be filled out by contractor "decontaminating lank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address: P.O. BOX 357 City: LODI Zip: 95241-01ri7 <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 <br /> •« ., aaaf,A,••.a•.• .•••a. a•f •.f•ar•,•,.••...••r•.,••lufu.fff«lr,a•••,f.•f•f•f!f••!if•••fflaa••!!• <br /> 4L 'Yank p1p1n� are Free p iii sludges asld htydrocarbop vapors u�o �i�� p y� UU-kk ii zer Steel . <br /> SECTION 4 - To a signed and date by an nut torize rep esenla ve o the realm o s al tact t <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: <br /> •••fa,♦„i!!t•a•a••«!••aHaf,•,!•t♦Va•aYaaa„N,•«••YfaaaafNa„t,!!Ht«tlHHa•!f!tlf a••♦i!lff Harf,r!! <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />