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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />•ttiitttttttittit Htttttttt Ylttit YYY>Hittttlttti4ttiYiititYYit»yiti«Y«>iNlt-Ytttlt�YiiYii Wii Htttb>ir«>ii> <br />SECTION 1 - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br />The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br />recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br />FACILITY NAME: Teresi Truckin <br />FACILITY ADDRESS: 900 1/2 E. Victor Road, Lodi, CA 95240 <br />TANKID#39- 1747-1 Tank Description: 12,000 gallon diesel <br />tttitlailaiYiWttttrt•t>t•itlWrtWf rtiitiiH lr4iiltt>ti M♦t»»•ii ti>tit»ltViai»»»Ytrrra>tiiit W>i«tttllt>t <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, Zip: 95241-0357 <br />Phone #: ( 209 368-6175 Date Tank Removed: 12/1/95 <br />tltlatW»t tt t t r tltY«Yilltitlat YWi WW»»Wrtirt>tr>ttaat««>YY»»»»»r>»>t>Yttt>t»i r Y t t Y t a«t«Y»«»t»t l t t t i t a a a!>t>t Yi <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: JIM THORPE OIL. INC. <br />Address: P.O. BOX 357 City: LODI Zip: 95?41-0157 <br />Phone #:2( 09 1 368-6175 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as required by Cal EPA. A <br />Title: PRESIDENT <br />yti Wt trtiittiitatii ati«4t Wtt! aaaat«>»#iit>liaitW«rt«Wrt iitili>YWWYrtrt ttt!>ttilYiittti!!!!Y •ltWWiW <br />IdnV( pipin�are free of ��fi slud�es aNd Udroc rbon vapors u o daeii�gdisp5�al a � zer Steel. <br />SECTION 4 - To a signed and date by an au orize rep sentat�ve of the reatme , Scor , <br />accepting tank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />12000 Folsom Blvd. <br />Phone #:( 916 ) 985-4810 <br />Date Tank Received: <br />Signature:_ <br />city: Rancho Cordova Zip: 95742 <br />Title: <br />«»ttaatrt YrtatiWrtrraii«i«♦ttt»WWtWrt«raarttil�ta««rirr»»a»»»ia»aaa«««»»»«»««iir»»»ri»t>:>Yirriitrii•»«»« <br />ER 23 049 (Revised 7-10-92) Page 10 <br />