Laserfiche WebLink
UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION t - Public Health Services Tracking Sheet will accompany each lank affixed with Its site Identification number. <br /> the Tracking Sheet R to be returned to Public Ileallh Services within 30 days of acceptance of the lank 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 EPA Site l� CAD 043274380 <br /> FACILITY ADDRESS: 900 1/2 E. Victor Rd. Lodi CA 95240 <br /> TANK ID #19 - Tank Description: 1000 gallon Gallon Diesel/ Gasoline/ Waste OIi <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim '1'Ixorpe Oil I Inc. DDA Hich-Mali Construction <br /> Address: 351 N. Beckman Hd./ P.O. Box 35'1 City: Lodi, CAp I, Zip: 95241-0357 <br /> Phone #: (209 ) 462-4581 Date Tank Removed: a {�M <br /> SE.Cl ION J - To be filled out by contractor "decontaminating lank': <br /> 'lank Decontamination Contractor: Jim Thorpe 011,DBA Rich-Mart Construction <br /> Address: 351 N. Beclonan Hd./ P.O. Box 35'1 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: (_ 20x 462-4581 <br /> Atilhorized representative of contractor certifying through signature below that the tank has been decontaminated In an <br /> approved manner as required by Cal EPA. / <br /> Signature: Title: <br /> SE,CIION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> ecce 1 k mVor Ipin <br /> lank is free �il �al� s�udgeg anfl hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folscxn Blvd. CIIy:Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 ) 985-4810 <br /> Dale Tank Received: <br /> Signature: Title: <br /> EH 23 049 (Revised 7.10- ) Pepe 10 <br />