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SAN JOAQL-L`I COL?TY PUBLIC HEALTH SERVICES <br /> ENtiTRONNIENTAL HEALTH DIVISION <br /> L-NT)ERGROL-T1 STORAGE TANK DISPOSITION TRACIONG RECORD <br /> •>a#»......#......##a##a......#aaiaaa.#..#a###ia##i#if4fi#a##a##iaa>a###i#......#i#>aa......i#aa#ai+#aay#>ya <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank af::xed%vith <br /> its sitz identification number. The Tars Tracking Sheet is to be returned to Public Health Services Eavironmea[a1 Health Division <br /> within 30 days of acceptance of the ca^c by the disposal or recycling facility. Tae permit holder is responsibie for ehsur;= that <br /> this fora is comoie:ed and remmed. <br /> FACILITY NA.IE: i ✓C <br /> FACILITY ADDRESS: .41 <br /> I <br /> TANK ID .,'39- TANK SIZE: .� 40i//. PPEVIOUS TA.NK COi-rEN7s:As�.�f Cd 649 S <br /> #�.#.ail}fiyi###iia......###iaa#iaaa######ii» ......... <br /> SECTION 2-To be filled out by tank removal contractor: <br /> Tar-k Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 677 E. Lockeford St. P. 0. Box 357 Cirr: I ndi CA Zip: 95241-0357 <br /> Phone 17': ( 209 ) 368-6175 Date Tank Removed: il r g AI <br /> ##a##1###iaa#a#i#iia.###ai####iaa#a#aa#ai##ii##a>#iia#a##i##i#a#.....*....... ..........##a#iaaa##...iaaa.# <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL. INC. <br /> Address:677 E. Lockeford St. , P. 0. Box 357 Carr: Lodi , CA Zip: 95241-0357 <br /> Phone.r: (_2_09 ) 368-6175 <br /> Authorized representative of contractor ce:rfving through signature below that the tank has been decontaminated in an aperoved , <br /> manner as recuired by Cal EPA. yg <br /> hfName: 4LAA.Ya,#.I i.(J4" Title: �P Signor re I s y u C _ Ca[e .moi <br /> nl�c'is i?` ee'o a #>a.iii <br /> T`a <br /> "Y �s�udces and h{drocrbon vaoo.rs open d�iix�r� �EgI�3s� S.t�el . <br /> SECTION 4 -To be signed and da"ted by an au hortze representative o . [rea me..t s )r <br /> acceding tank and/or piping. <br /> Fatuity Name: Schnitzer Steel Products <br /> Rancho Cordova , CA <br /> Address: 12000 Folsom Blvd. Cir-: Z:o: 95742 <br /> Phone,;: ( 916 ) 9/8/5-4810 <br /> Date Tank Received: `—r7 a <br /> Name (961; T;tle:Ba Sig^an:,+. Date D � <br /> ....................ai.a#a........................a.a.......#>ia......a........iaa>aa>#.i=.ya#a>.a.=ii..i. <br /> EH 23 046 (Revised 03/13-5/99) Page 10 <br />