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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />rrruu•r••ruur••••ruu•••r••u•••u•u#•uu•u•uuuuu•#•••u•••r•••••••uuurrrr•urr•r•r••••rru <br />SECTION f - Public Ilealth Services Tracking Sheet will accompany each tank affixed with Ila site Identification number. <br />The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the lank by the disposal or <br />recycling fncility. The permit holder Is responsible for ensuring that this form is completed and returned. <br />FACILITY NAME: Teresi Trucking <br />PACIU'IY <br />112 E. Victor Rd Lodi. CA <br />TANK ID #39 - 17N7- z? Tank <br />gallon leadgd gasoline <br />•usurff.•.••••##.f•.••••.••••f•f••1#•,••}.f#•uu#Iuu•#•ur••u•••t••r•.•urr••••••u•u•rr••r•rr•••••• <br />SECTION 2 - To be Pilled out by lank 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: /! 7l`i r <br />........•..,......1....#.#11.1.f..•...af„f#,a...1..............+.:....,..•.•t•••f ••,.••.•....••••.•.•f••• <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: g5241-019;7 <br />Phone #:(209 368-6175 <br />Anihorizcd represcnlative of contractor certifying through signature below that the lank has been decontaminated in an <br />npproved manner as required by Cat EPA. <br />Signature: <br />Title: PRESIDENT <br />♦ •f A♦ 1#�11�t11•f••f f!!tf• !#ff 1#1#1.111 #11tH Mf}f}}•}fflff#IIIIIfff###tf!•#tfff11f1ttf •#f t1111tt1f •#• <br />tan pip1n%are tree # �lT sludges acid hydr9carbop vapgrs 9Ro31 g�iX�CtYsps�al is 5i�y zer Steel. <br />SECT ON A - l'o a signed and date by an no wrize rep sen n ve o the r gime o <br />accepting tank and/or piping. <br />Facility <br />Phone #:( 916 <br />Date Tank <br />Schnitzer Steel Products <br />12000 Folsom Blvd. <br />985-4810 <br />city: Rancho Cordova Zip: 95742, <br />Title: <br />♦1111111#rlffltN•}}111.1#11.11•#HIT ItIR}##f#IIMt#f#11111t1#••#It1t}fft#t#t#1tf•t••••}••?•t••#•r1r!#•• <br />EN 23 049 (Revised 7-10-92) Page 10 <br />