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SAN JO COUNTY PUBLIC HEALTH SERVI%-A <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ++#+a#+#4#rir+ir#t««rlrtaf+#rrf#rarrrt+lr+#rrf##f•++ctrl#+#fr+rt4t+r w+t#4l♦##t#1#rrr#ll#►#►##►##►#►#►*#►##►►#► <br /> SF,CI'ION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> Milt 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 rank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: <br /> Tri Star Homes, LLC E.P.A. # CAC001166584 <br /> FACILITY ADDRESS: 1325 N. Corral Hallow Rd. , Tracy CA 95376 <br /> TANK ID #39 • k-:!0-15 TANK SIZE: 800 PREVIOUS TANK CONTENTS: ld gasoline <br /> +raaaaa}a++#aa}#+++#af!#+a4!!•«rf+4f!#+##4#lrt++r#a##i+#«#4}ff+rf#+!f►+#4Tl+rl4###1#lr###►►####►#1###f1#### <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor. Jim Thorpe Oil luc. <br /> Address:_ 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA/ Zip: 95241-0357 <br /> Phone #: ( 209 368-6175 Date Tank Removed: o <br /> 9191 <br /> +}#+a#a}}#!!##!!!4#+4#+#r#«f+#fw#+#tf++rlft##!#+rff+#lfrr++r##+ l+4#!l#r##trt#l!###►######►#•+#f##rt#######►► <br /> SECTION 3 - To be filled out by contractor "decontaminating lank": <br /> lank Decontamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City; Lodi, CA Zip:95241-0357 <br /> Phone A: (_209 ) 368-61'(5 <br /> Authorized represematNe of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: " fSignature: Date (Q`Z 9 <br /> 1`anfca saf#ree of"aYf##slodg#es}#ani+ h�y7#ro`�arbonavrarors'uppon+rdeliverrg o drill ee�«►►#M## <br /> SF,CT'ION 4 - To be signed and dated by an aul orize represents lve of the treatment, sto a e, or s s aeil <br /> ty <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. City; ZIP: 95742 <br /> Phone p: ( 916 ) 985-4/810 I <br /> Date Tankk Received: La L t- <br /> Name: s J O,(31 QC_ Signature: Date G► <br /> r+}}+4«+#}+art+fr!#+##+#rfi44r4ff#!a+#++w4#r+•«#+r♦!«f•w4+«4#4444+♦#?####4###rt!###1##►#►#4+##►#+#1►###►#+ <br /> Ell 23 046 (Revised 9111/96) Page 10 <br /> 1 <br />