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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD SECf1ON I - 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 days 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: Schmiedt Family Properties - Paulette Trainor FACILITY ADDRESS: 8924 E. Acampo Road , Acampo, CA 95220 TANK ID #39 - NA Tank Description: EXEMPT 500 gallon diesel Ag Tank & piping SECTION 2 - To be filled out by tank removal contractor: Tank Removal Contractor: JIM THORPE OIL, INC. Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODT, Zip: 95241-035'7 Phone #: ( 209 368-6175 Date Tank Removed: December 26 , 1995 .............................................•.............................,............................... SECI'ION 3 - To be Filled out by contractor 'decontaminating tank': Tank Decontamination Contractor: JIM THORPE OIL, INC. Address: P.O. BOX 357 City: LODI Zip: g5?41-0357 I Phone #: (209 1 368-6175 Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as required by Cal EPA. Signature: / k//.X.ter/ � �vkLI Title: PRESIDENT •• •• •,a••s..••..•. .•••.• ..• ••,•.•,%iesa.,•...•,....•„••.••,,,,••.,.,.••.••••..•..••••••.••,...,.•. Yank f plp)nt� are free o �� slud�es a�td mdrourbop vapors urRof d�g�i8p spl�al e�il� zer Steel . SECTION 4 - To a signed and date by an aut orize rep esentnt ve o the reatme ora , accepting tank and/or piping. Facility Name: Schnitzer Steel Products Address: 12000 Folsom Blvd. City: Rancho Cordova Zip: 95742 Phone #: 9( 16 1 985-4810 Date Tank Received: 9(0 Signature: + LL U Title: ......•.,.•.•..................•.....................................•,...................•............. IN 23 049 (Revised 7.10-92) Page 10