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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD •••••.•••••••••.•rr••••u•••••••••••••••••r•u•••••rr••r•r••r•••••r••••r•r•••r••r••r••rr•••r••••H••r•••••• 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 da.1s 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. FACILITY NAME: Donald Colvin EPA Site #CAC 000898968 FACILITY ADDRESS: 225 S. Cresent St. Lodi, CA 95240 TANK ID #39 - (q 33 -V Tank Description: 280 Gallon Diesel/(Gasoline4 Waste Oil SECTION E - To be filled out by tank removal contractor: Tank Removal Contractor: Jim Thorpe Oil Inc DSA Rich-Mart Construction Address: 351 N. Beckman Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 Phone #: (209 ) 462-4581 Date Tank Removed: cp I �o I `�y ••••.••••••••••••••••••••••••u••••r•••r••••r••r•••rrr•••rrr••••rr••u••••••r••••••u•••r•••••••Hr•rr••••• SECTION 3 - To be filled out by contractor "decontaminating tank": Tank Decontamination Contractor: Jim Thorpe Oil DBA Rich-Mart Construction Address: 351 N. Beclunan Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 Phone #: ( 2091 462-4581 Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA. Signature: 124 Title: SECTION 4 - To be signed and ddd/�ated by an authorized representative of the treatment, storage, or disposal facility Tank is freeR�it �I s�udgegipaM hydrocarbon vapors upon delivery to Schnitzer Steel . Facility Name: Schnitzer Steel Products Address: 12000 Folsoin Blvd. City:Rancho Cordova Zip: 95742 Phone #: 9( 16 1 985-4810 Date Tank Received: Signature: Title: ............•.•••.•.•..••.••.•.....•...•...•..••..••....•...•..••.••.•.....•.•.•.•••••.••••••..••..••r•• Ea 23 049 (Revised 7-10-92) Page 10