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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SEUrION I - Public Health Services Tracking Sheet will accompany each tank affixed with Its site identification number. <br /> ne Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br /> rccycifng facility. The permit holder Is responsible for ensuring that this form is completed and returned. <br /> FACU IY NAME: Teresi Trucking <br /> FACiLT IY ADDRESS: 900 112 E. Victor Rd Lodi CA 95240 <br /> TANK ID #39 - 1-7 7- Tank Description: <br /> ►#�*#!####!!*#!!!##!ii!!!!f#####!1•***R#!!!*#1####R####il11!#####ii#####i##•#!###f!##!##f!###f!####4##!#!f! <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.O. BOX 357 City: LODI // Zip: - <br /> 0357 <br /> Phone #: (209 ) 368-6175 Date Tank Removed: fad- ` qS <br /> ###f iilA!*1!#!!!#!!i#111!#####i!f*!♦1##4#*#!i!###*f#►#*####ii##11#####i!*#i!###1###f####!f#####!#if#!!##!!i <br /> SECTION 3 - To he filled out by contractor "decontaminating (ank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address: P.O. BOX 35 City: LODI — Zip: 524 <br /> Phone #: ( 209 ) 368-6175 <br /> Anthorizcd representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cad EPA. <br /> Signatare: Title: _ PRFs D_,_I ENI_ - <br /> *# !♦ ♦*�!'�####*#!* !*!*!!!#!** 1##ii###►#f 1!#####1iii##i!#1!##!###i*fi#i4f#*!f#*#!f#ff#i4ffifff####f##! <br /> Yank i pip nc� are free pf $1 sludges agd h�drocflrbap vapgr5 u o �aeg�i� 'sp i�al a i �} zer Steel . <br /> SECTION 4 - � a signed and dale by an nu iorize rep sentnt ve 0 the r attne or , <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 Recefved: 2.1 Lei <br /> q <br /> Signature: Q Title: <br /> !►#1sit!!1###!#!f#sii#111ft###!!!i##!!#ii!#i###!!##1#!!!######!#!#*##*#!!###4#f!#*4f!####!##f!#f fflfil#! <br /> ER 23 049 (Revised 7-10-92) Page 10 <br />