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1 <br /> i <br /> i <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ' A!!l4f4fttfft4f44f#ffttlf4tfrft4fff!#rf!!lfffflf44flflf#fff4ftlff4l4#t4#!4!!#4#!#f#rr#####t##4#t#########f# <br /> SECTION 1. - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br /> d to Public Health Services within 30 days of acceptance of the tank by the disposal or <br /> The Tracking Sheet is to be returne <br /> ible for ensuring that this form is completed and returned. <br /> recycling facility. The permit holder is respons <br /> FACILTI�I NAME: <br /> Don Rodgers CAC 000737776 <br /> FACILITY ADDRE W. Charter Way, Stockton, CA 95206 <br /> TANK ID #39 - -V&&) 550 gallon gasoline <br /> �� I Tank Description: <br /> !lt4t!#t4#l44f+14fff4t4t4#f#4tft44lt#t«#4l4f«tt##4#4#f4f!#!#!#!##4#!t!t##f4ff#t4f#!f#flf tt4rlr4frf r+Itlt44r4! . <br /> SEC'T'ION 2 - To be filled out <br /> by tank <br /> removal <br /> OILcontractor: <br /> o tra tor: <br /> Tank Removal Contractor: u <br /> Address: 351 N BFCKMAN RD / P.O. BOX 357 City: LODI, _ Zgipsgo��41_0 i57 <br /> Phone #: (209 J 368-6175 Date Tank Removed: I L ` <br /> 4t4t«#ttt►«t«!«t4ttt4t«♦«ttttitttt«t«4t«tt4t4tt«tt4t4tt«««t«t4ttt Ott tfttfttf#f#r4444f##fr4lf44rlf#lffrf#fry <br /> SI.C'l'ION 3 - To he filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC <br /> Address: P.O. BOX 357 City: LODI Zip: 95 AJ-0 5-7 <br /> Phone #: (2_09) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA. <br /> � Title: PRFST_DENT <br /> Signature: <br /> 44 #t t#�44114!!it!#t t4t4#44«4t #t«t#4#4#tt�4tt#ttt4ttt4t««t4#.44tt4#4t!#!##4ttlt4ff#rffrf#r###tzertSteel . <br /> anC p�pynqq are Free of a� sludges apd h�droc rbop1 vapgrs ting, �i�� spspal i Jyt <br /> SEC'T'ION 4 - 'To be signed and dated by an nutltorized repl"esentat ve o the r atme o , <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. city: Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 ) 985-4810 <br /> Date Tank Received: <br /> Title: <br /> Signature: <br /> t4f#tltt4##t444tf4tt4l4tt#f#Oft#tit44f#!4t#lt44!!4!##l44t4#♦#t#tr#4###f4#lf4f44f#4r4r#r#r#4##r#f######!# <br /> ER 23 049 (Revised 7-10-92) Page 10 <br />