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T <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION t - 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: Donald Colvin EPA Site #CAC 000898968 <br /> FACILITY ADDRESS: 225 S. Cresent St. Lodi, CA 95240 <br /> TANK ID #39 - Tank Description: 280 Gallon Diesel/ Gasol inek Waste Oil <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jinn Thorpe Oil Inc DBA Rich-Mart Construction <br /> Address: 351 N. Beckman Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357_ <br /> Phone #: (209 1 462-4581 Date Tank Removed: <br /> SECTION 3 . To be filled out by contractor "decontaminating lank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil,DBA Rich-Mart Construction <br /> Address: 351 N. Deckman Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: ( 209) 462-4581 <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: <br /> SECTION 4 - To be signed and ddlated by an authorized representative of the treatment, storage, or disposal facility <br /> Tank is free��ti��j�s�udgegipa'A hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 F'olsoin Blvd. City:Rancho Cordova Zlp: 95742 <br /> Phone #: 9( 16 ) 985-4810 <br /> Date Tank Received: <br /> Signature: Title: <br /> EH 23 049 (Revised 7-10-92) Rage 10 <br />