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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONWNTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <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: JUNE KEMALYAN E,P.A. li CAC 001244600 <br /> FACILITY ADDRESS: 5328 E. Acampo Rd. , Acampo, CA 95220 <br /> TANK ID #39 - <br /> N/A TANK SIZE: 350 PREVIOUS TANK CONTENTS: diesel <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 C ( 209 ) 368-6175 Date Tank Removed: May 1 , 1997 <br /> #{*###*+#*##+*##4*+####fi{##4###+fi#i+##f###i#it###+t#!#fi+!#ltf4i!##++!#it4##ft##fttf##!f#•##f#4###f#fff#f+## <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 N: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in in approved <br /> manner as required by Cal EPA. may, / <br /> Name: Martin Thorpe Title: Vice-President Signature: p t uvu�-jDate May 1 , 1997 <br /> #la*n*k*{f#ree'o #aYfftsluage*s#ani#"h�yd'rocar6onivapors fupon#td"efiiver g o <br /> SECTION 4 - To be signed and dated by an aut orized representative of the treatment, gto a e, of is s acil 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 y: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Nam �Title: Signature: Date <br /> Ell 21046 (Revised 9/11/96) Page 10 <br />