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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ###+##*****rtrt*#+*Wrtfi*####rtrt***####w##W###WWrtrtrt+rtrt#rt##firtrt##rt#+rt#*#rt#WwWw#W##++rtW#+#+#####++rt++++rtrtrtrtrtrtrtrt*rt*# <br /> SECTION 1 - 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 NAIME: Zoya 0. Bryner E.P.A. # CAC 000768648 <br /> FACILITY ADDRESS: 764 E. Hazelton St. , Stockton, CA 95203 <br /> TANK ID X39 - TANK SIZE: 1 ,000 gallolpgEVIOUS TANK CONTENTS: gasoline <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil , Inc. <br /> Address: P.O. Box 357 Cin,. Lodi, CA Zip: 95241 <br /> Phone q: ( 209 ) 368-6175 Date Tank Removed: <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. , Cin: Lodi, CA Zip: 95240 <br /> Phone b: ( 209 368-6175 <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: Title: Signature: Date <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: <br /> Schnitzer Steel Products <br /> 12000 Folsom Blvd. Rancho Cordova, CA 95742 <br /> Address: ity: Zip: <br /> Phone k: ( 209 ) 985-4810 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 9/11/96) Page 10 <br />