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I I UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD '. r.♦♦•r..•r....•...•.•••r.,r..•.....ru..•..r.•♦.rr....r.•u.............•..•..r•...rr.r...•...•••...u..... SECTION t - Public Health Services Tracking Sheet will accompany each tank affixed with Its site Identification number. The Tracking Sheet Is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder Is responsible for ensuring that this form Is completed and returned. FACILfIYNAME: J.H. Simpson Company EPA /ICAC 001189064 FACILfIY ADDRESS: 4025 Coronado, Stockton, CA 95204 TANK ID #39 - - Tank Description: 2,000 gallon ul gas .♦.•.♦..r••.rr..•••.....•....,.,.♦♦r.•.•u...,.r••r.••..,..»u......r.•rr•u.•...r......rr•.....r....r...• SECTION 2 - To be filled out by lank removal contractor: Tank Removal Contractor: JIM THORPE OIL INC. Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LOD�I7 C Zip: 95241_0357 Phone #: (209 368-6175 Date Tank Removed: I SECI'ION 3 - To be filled out by contractor "decontaminating tank": Tank Decontamination Contractor: JIM TIIORPE OIL INC Address: P.O. BOX 357 City: LODI Zip: C19241-0197 Phone #: (209 ) 368-6175 Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as re Bred by Cal EPA. / Signature:_ Title:Tide: PRESIDENT .r .r r. .,p.qq...rrrr .•..rp�••a. ••..• rQQs•••r.t1.,..•.u.•••.,r...•.....r..ru.�.{•...........rrC,u. ........... SECTION 11UN 4�P�nolte signed,od dated by unlal�ill o�lzed dep sla/n�ve ointhea�,par, ner��s�olaeg�i�� sp�fpal'SA"J) zer Steel . accepting tank and/or piping. Facility Name: Schnitzer Steel Products Address: 12000 Folsom Blvd. city: Rancho Cordova Zip: 95742 Phone #: 9( 16 ) 985-4810 Date Tank Received: Signature: Title: _ \ ......,ur••.rrr.•.u.•r.,• .•..rrr.rr ....r,ru.r..r..rr..,.••...rr...........r•.r..r..r.u....H..... Ea 23 049 (Revised 7-10-92) Page 10