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SAN JOAQUIN COUNTY PUBLIC HEALTH SE�CES <br /> ENN-MONNEENTAL HEALTH DIVISION <br /> LN-DERGROLTND STORAGE TANK DISPOSITION TRA CIUNG RECORD <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its sire identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> he disposal or recycling facility. The permit holder is responsible for ensuring that <br /> within 30 days of acceptance of the tank by <br /> this form is completed and returned. <br /> FACILITYNANIE: L.R. Varwig Property <br /> 16500 E. Brandt Rd. , Lodi, CA 95240 <br /> FACILITY ADDRESS: <br /> TANK ID#39- TANK SIZE: 2 ,000 PREVIOUS TANK CONTENTS: Unleaded gasoline <br /> SECTION 3-To be filled•out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 677 E. Lockeford St. P. 0. Box 357 City: Iodi (A Zip: 95241-0357 <br /> Phone#: (209 ) 368-6175 Date Tank Removed: <br /> YYifiiY#ifi#Y#YY##Y####Y####Y##fifi#fi#Y##Y#fi#i##ii#YY#fii#Y#fifi###Y#Y#Yfi#######fi##YfiY###�###Yfi##.#fi#i###YYYfifi##YY <br /> SECTION 3 -To be filled our by contractor "decontaminating tank": <br /> Tank Decontaminadon Contractor: JIM THORPE OIL INC. <br /> .address:677 E. Lockeford St. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone,: ( L09 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved . <br /> manner as required by Cal EPA. <br /> Name: <br /> Title: Signature: Date <br /> Y iI1#Y# ## ## ##Yi###i fii##iY###ifi#ii#i#fi#sYYi#Yi####fi#Yi##Y#Y#Yi#fiY#fi##YYfifiaYi#fiY##Y##Y#ifi#Y <br /> Tfian'1c is free o a'Y s'�u e5 ani h drocarbon vapgrs y�ntre�aPt�tj�er a� 3F�ns ac5iVel <br /> SECTION 3-To be signed and d2ted by an authorised represen a ive o e t, s r <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. Ciry: Zip: 9574 <br /> Phone#: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Name: <br /> Title: Signamre: Date <br /> Y#Y###YY#YYY##YY####Y###iYYY##YYiYY#YY#Y#fiY#fifii#fi###ifi######Y##YY##Y##YY####i##Y##Y#.YYYYYYY##Y#fi.a#YY#Y# <br /> EH ZS 046 (Revised 08/1:/99) Page 10 <br />