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UNDFRGROUND STORAGE TANK DISI'OSIT-ION TRACKING RECORD ••.•.••••••••••••••••••••.•.•.•.•.•.•.•.•.•.••••••••••.•.•••••.••.••.•.•.•.••f••••a a a 0 a a•1••1••J••••••••••• sr.ul ION l - Public I lealth Services Tracking Sheet will accompany each lank affixed with Its she Identification number. lhe 't'racking Sheet Is to be returned to Public Health Services trllhln 30 dors or acceptance of the lank by the disposal Or recycling facility. The permit holder Is tcaponslble for ensuring that [his form Is Completed and returned. FACILIH NAME! Teresi Trucking EPA Site CAD 04327438Q— FACILITY ADDRESS: 900 112 E. Victor Rd. Lodi CA 95240 TANK ID N39 - Tank Description: 1000 gallon Gallon Diesel/ Gasoline/ Waste Oil. SF'(:I t - To be (filed out by lank removal contractor: lank Removal Contractor. Jia, '11101-pe Oil I Inc. DDA Rich-(dart Conslrucl, Address: 351 N Beckman lid./ 1'.0. Dox 357 City: Lodi, CA Zip: 95241-0357 Phone #: (209 ) 462-458 i Date Tank Removed: SF.(,1T )N J - To be filled out by contractor "decontaminating lank": lank Decontamination Contractor: Jiu1 'lhorpe 011,UBA Rich-Mart Constructlon Address: 351 N. Beclonan lid./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 Phone #: ( 209) 462-4581 Authorized representative of contractor certifying through signature below [hal the tank has been decontaminated in an approved manner as required by Cal EPA. Signature: Title: ....••.•.••••.•.•.•.•.•.•.•.••.•.•••••••.•.•.•.•.•.•.•.••.••.••.••.••••.•.•••••••••••••u••••••••••••••••••. SFGI ION 4 - To be signed and dated by an authorized rcpresenta(Iee or the treatment, storage, or disposal facility acret k n lailk Is free �if %ly s1u((yegIp1n an�l hydrocarbon vapors upon delivery to Schnitzer Steel . Pacillly Name: Schnitzer SLeel Products Address: 12000 Fols(xn Blvd. Ci(y:ltancho Cordova Zip: 95742 Phone d: 9( 16 l 985-4810 Dale lank Received: Signature: Title: Ea 23 01.9 (Revised 7-10-92) Page 10