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N <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> rir#t##Y##f#####4t######»#tt4##rtitiY#•ir»i4i#}#f#it4*ir#4#tff44#Y•*4*#•!r**####}####Y##f#f•i#t###ri»»##### <br /> SECTION 1 - 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: 400 1/2 E. Victor Road, Lodi , CA 95240 <br /> TANK ID #39 - 1747-1 Tank Description: 12,000 gallon diesel <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 351 N. BECKMAN RD. / P.D. BOX 357 _ City: LODT, Zip: 95241-0357 <br /> Phone #: (209 ) 368-6175 Date Tank Removed: 12/1/95 <br /> *»»rf4##*4trtr#fi#####i»r»#»}########r#rr#»#»;#Yr##tYi##r##**#####**4*Y•rt###f*########ii#i*YYY*###i#r##Yi# <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL TNT. <br /> Address: P.O. BOX 357 ___ City: LODI Zip:-. 99241-0-157 <br /> Phone #: 2( 09 ) 368-6175 <br /> Authorized rcpresentative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA. <br /> 9 Title: - PRESIDENT <br /> Signature: <br /> i» •# » #r#r»t*### ##it#*r#ir#it##*#f•Yri4#r###r##r}#}#}tt#######*#*YY####}#»»#f#########»Y <br /> IfA � plpin� are ree Qf AM sled%es a�d htydroc rbop vapors u o deli8prd�r tp ��rrhh zer Steel <br /> SECTION 4 - To a signed and date by an Uut orize rep esetttnt�ve o the reatme , Sora sp a! IaCtl� <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordova Zip: 95742 <br /> Phone #: L216 ) 985-4810 <br /> Date Tank Received: ltq'' ':q/ <br /> Signature: CY Title: <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />