Laserfiche WebLink
Y <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />H r#.♦Nr#f#rN r#f.•f♦r..•r•#•,r###.r•.•.•.••#••..•..,•..f..,.,r.#..r,r,rrrr#r#+ffr#.rrrr#.r......N.rr.r.r <br />SECTION I - Public f leallh Services Tracking Sheet will accompany each tank affixed with its site identification number. <br />The Tracking Sheet is to be returned to Public Ilealth 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 <br />FACILITY ADDRESS: 900 1/2 E. Victor Rd Lodi I CA 95240 <br />YANK ID #39 - /7N7- f2 Tank Description: 5,000 gallon leaded gasoline <br />H....fa..fff#.....f#..a....a####.H,.H.##.�.1.fR....1.1,#.111...•#####f..N.#. H.#.#..1 .1#.f#f,#,f.ff• <br />SECTION 2 - To be filled 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 Dale Tank Removed: <br />...........#......y.•,.H.HH.#,•y>,##•J.##•>1,..#NH,M„A##1.1.M,NH•••.••1H##...y•##.ffr♦#.•f1....1 <br />SECTION 3 - To be filled out by contractor "decontaminating lank": <br />Tank Decontamination Contractor: J1M THORPE OIL INC. <br />Address: P.O. BOX 357 City: L.ODT ZIP: 45241_0357 <br />Phone #: (209) 368-6115 <br />Aulborized representative of contractor cerlirying through signature below that the tank has been decontaminated In an <br />approved manner as required by Cat EPA. <br />Title: PR&SIDFNT <br />Yankk• h•fi•• riQQf�ere*ree o•�.#.7......• pfe *'C)Cft##..yy.....frhoV...,.....,.#•.#,.{.f7h#f.fzer S. <br />SI?C1'IONp4 � o be signed and datedlby anlna0 orized depnesenolnl�ve o�theaitFatln_gR°s of Jigp sp�Syal Ac1��} ter Steel. <br />accepting lank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />12000 Folsom Blvd. city: Rancho Cordova Zip: 95742 <br />Phone #:( 916 ) 985-4810 <br />Date 'tank <br />Title: <br />•>•f.#•.....♦.!!•###!##!•1.•••••#,♦•1#t,##.f♦!.#..•!••••##•!•♦#,#.•.tf,.>too <br />•1#f,•##f♦,!r#rf##.#..ff.f rr <br />Ea 23 049 (Revised 7-10-92) Page 10 <br />