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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> r++!!rl+i##+►rr#►r4t►t#rrrtwra4wr#r#►i:#4rrtrw+#rtr4+#rrrr#44rr++rt4►►+rrt#t4tttttwrwwt#rtw#ttttwtttw►twttww4t <br /> SECTION 1 - 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. # CAC 001166584 <br /> FACILITY ADDRESS: 1325 N. Corral Hallow Rd. , Tracy, CA 95376 <br /> TANK ID #39 • TANK SIZE: 300 PREVIOUS TANK CONTENTS: ld gasoline <br /> +rr+rlr+t*rrl4rt++#rtriir4r►ir4#rii4#rtwt#44rr##+i4r#ri#wr4+t#r44#tr#rtiit4w+44#i4+rtrtrtt4twwt#rtwtw4r4rtt►#rt+#w <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, CA Zip: 95241-0357 <br /> Phone #: ( 20_) 368-6175 Date Tank Removed: <br /> +r!#!!##4#!rr#t!►rrr#4#r►!r###rrtrrrr##frrr##rt►rr4##rr##►♦rrttir!###rt#t4##at#4►w#4rr!##tttrtrt4w#t44wwtttw#t <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 #: ( 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. <br /> Name: Title: Signature: Date <br /> rr#+#t!4!#!#rrr####►wrrttrrtti###rtrtrtrlrtrrli44wr##t#ifrtrtr#tit#t#wrrt#t!#www4rttwlw4twwtt4M►#tt4wt#rtw►r##rt4wi <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank andtor piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. City: Zip: 95742 <br /> Phone#: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> *Mr#r*r+++#+4rrr###+rt#i#4####f#!###4+!#rr#4#4►t#rr4►rt44►►►4►l4rttr4r#r#i#rt#rtrrlr►rtrtrt►#*r#4r*#!lr+++*!irt*+ <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />