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y <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />}t♦1>Nf1H!!H•IINl1H1!•i•##HI•NfMM#!f1•!!illU•1!N!•!1•###tHl1•••. •!•••.!•»••. M•#>••1Hp••#»> <br />SECTION I - 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 Trucking <br />FACILITY ADDRESS: 900 1/2 E. Victor Rd Lodi, CA 95240 <br />TANK ID #39 - /-7dj — I Tank Description <br />12,000 gallon diesel <br />1lHtf!!!!tf##1>1tt"}ltltf!###I11+1!#IM>#»1}}#>tt}!!#»>1!!}##>!>!f#R!#####t!##}#!!!•1141•! #•!•••••!#»••♦ <br />SI?CI'fON 2 - To be filled out by lank removal contractor: <br />Tank Removal Contractor: JIM T'HORPE 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 />♦11!11!#1111###!111!!#ft11111!###fH#!#!###ft}}!!!}#11!!####!!!1####1#11#!•11!#!#•!!#11r11••!R•••!!!!•••!••> <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: IODT Zip: 85241-0'157 <br />Phone #: ( 209 368-6175 <br />Authorized represetnative of contractor certifying through signature below that the lank has been decontaminated in an <br />approved manner as required by Cal EPA. <br />Title: PR SIDFNT <br />f• 1♦ a#t1>f}>1}.#1# ♦>!!t1!### !!!!stir###11>lit:#1!!ltltt}###1#tlttt!!}}f##1>•+,!##•••#»1•••••1•••#!#1 <br />sank plp %are free pf ��� slud�es astd hAdrocirbop pRar tRof � jigpVSpbWal1 Ail' er Steel. <br />SECTION 4 . �o a signed and date by an nu mrize rep sentnt ve o the r al ne o Pg , <br />accepting tank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />12000 Folsom Blvd. city: Rancho Cordova Zip: 95742 <br />Phone #: f 916 1 985-4810 <br />Date Tank Received: <br />Title: <br />####f!!>fI#Irlt>t1#1#t!#:f}#t#}#####rrtlesat:#####>!#»t1#!!t}####!1!!11>11t##•!#>41!##}44}1!•4!!!1>1.11 <br />ER 23 049 (Revised 7-10-92) Page 10 <br />