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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />#r1•♦♦!!!!•R••u♦H•!•1}••r•f/r/r!R!••!•r+;1•!!;•!rt•••#;rtlflff/♦rfrffrfR/•#1#/#/♦r/11//H/11/r11H♦//}u/ <br />SECt1oN t - rublic Ifenlih Services Tracking Sheet will accompany each tank affixed with Its site Identification number. <br />The Ttncking 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 />FACILI"IY NAME: Teresi <br />FACILITY ADDRESS: 900 1/2 E. Victor Rd Lodi, CA 95240 <br />TANK ID #39 - ) 707-Z_ Tank Description: �< <br />111f1lfI H1!•!f!l M1t•;!!f#•U#}tHHI}111#•MI.1•f•Aft•RR#}flMl}};;#Mf!!•tt1111 f1!##l1111H1/1N//1f#1111 <br />SECI ION 2 - To he 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: <br />....•.H•yH••r•11}♦•RI•I1••!.•l;1Hl1l M•;#1Hf•y •!1•!!11!•1•#•111#11111;1:11#/R•1f/f####1111#111#R1.1111• <br />SECTION 3 - To be rifled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: JIM THORPE OIL INC <br />Address: P.O. BOX 357 City! LODI ZIP: 95241-0-357 <br />Phone #: ( 209 368-6175 <br />Authorized representative of contrnctor certifying through signature below that the tnnk has been decontaminated in an <br />approved manner as required by Cal EPA. <br />Signature: <br />Title: PRESIDENT <br />♦ R# f♦ 1R(l ljlrll•�•Rf tf♦R!! !1.1 NU!/}!#i1•Hf1ff!}1f}IttR##1••Hff1RR!lRM;!##R###f M/1RffR##RJRM1f# <br />ian� pipIn arg tree �1 Y slu��es aXI 1r drjchrbof1 iv rt tfo ra%t,'XpWspbpall&h"lytzer Steel. <br />SEC"I' ON 4 - �'obe sh ned and dale b an nu torize re esen n ve u the r arae or <br />accepting tank and/or piping. <br />FaclntyName: Schnitzer Steel Products <br />Address: 12000 Folsom Blvd. <br />Phone #:( 916 ) 985-4810 <br />i <br />Date Tank Received: Iajl & A J <br />Signature: <br />city: Rancho Cordova Zip: 95742 <br />Title: <br />♦11#1}1l1fl111H1f 11111111 H!111R•1!}!}f1•f1t1!#}M;Htf1###R1ff##1#}H##•;HlH##!#1•#♦H#RHHfHN•�f <br />EN 23 049 (Revised 7-10-92) Page 10 <br />