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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ++++#####t##4f+r#rtt+f4+;lfrr#t#+rfi+f##+##!rt##!4f###4f#44#!4#;#r!#!!#ffr!!4!1\#\\!##\4#f!►\#►►►\\\ff►+\\r►► <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: Tri Star Homes, LLC E.P.A. if CAC 001166584 <br /> FACILITY ADDRESS: 1325 N. Corral Hallow Rd. , Tracy, CA 95376 <br /> TANK ID #39 - 13ZS O i TANK SIZE: 300 PREVIOUS TANK CONTENTS: ld gasoline <br /> Y+#Y+######4####ft#>#;44!!f;#ltr;#;!;#!lfi4r#rt#+44rl4t!###l+44###f#;+#rrf+\4#4###1!\!#4rr\\\\►+#!\r\#\!#44#r <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: <br /> nLodi I CA Zip: 95241-0357 <br /> Phone N: ( 209 ) 368-6175 Date Tank Removed: q9_7 _ <br /> #######+#rt##+###+;#;;;rl;fro##f!!;!tlf;+;ft#r;4+!######;rr;w!#f####�\r\4!##\\\►##;rrl+44t#!#\+##rt;4 <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 p: ( 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. f n <br /> Name: itle: t/ /' Signature: mfg Date <br /> 19 Yf *lYe'6*Vf"ST I- 3h�1*Ry21f'dL3fb'Sri'G'a"�8fa�"� f$i�"d�15Ve`r�jr'4"o'S�Ah-f�er"S�eeY\\.\.!## <br /> SECTION 4 - To be signed and dated by an authorized representative o�the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> 12000 FlBlvdRancho Cordovat CA <br /> Folsom . <br /> Address: City: Zip: 95742 <br /> Phone p: ( 916 ) 985-4810 <br /> Date Tank Received:�� j a- a ? <br /> Name: Signature: Datetol/Tq 7 <br /> EN 23 046 (Revised 9/11/96) Page 10 <br />