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i <br /> V <br /> UNDERGROUND STORAGE TANK msrosnm TRACKING RECORD <br /> 14!4♦#!4!##!##iii#R##4lRRRI!•ffffi#!i#!4f#f##!R###tRRf#RRf♦##flf►*fillli#ii####ifi#lflfif####*#####i#####i# <br /> ;i.MON I - Public Ilealth Services Tracking Sheet will accompany each tank affixed with Its site identification number. <br /> i"he Trnckfrng Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br /> •ecycling Mcitlly. 1-he Permit holder is responsible for ensuring that this farm Is completed and returned. <br /> �ACif J-Y NAME: Teresi Trucking <br /> -ACiLI'iY ADDRESS: 900 1/2 E. Victor Rd Lodz, CA 95240 <br /> i'ANK 117 #39 - 17417_- Tank Description: +0 gallon leaded gasoline <br /> •!lf414rr1f lta!}}Rita!!!•!f!!#}}Rr!#lr4alfatal!#!!•fla4#daft!111fflflf!#RffllfRi#Ri!##flfRf#iiififilllflllf <br /> 'ITCiION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> lddress: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODI, zip:-.-q5241-0357- <br /> 'hone <br /> ip: 95241--0357-'hone #: (209 ) 368-6175 Date Tank Removed: <br /> •11ai♦rraRria♦!aria!#aa#a!##!#1#aaaf atl!•r11111l1111/1lR1r!!a!#1#!}}•it!#!#!#ta illi lff!#1!##f 4fRf#f##fi##if <br /> ;E(;TION 3 - To be pilled Brut by contractor "decontaminating lank": <br /> rank Decontamination Contractor: JIM THORPE OIL, INC. _ <br /> lddress: P.U. BOX 357 City: LODI - ZIP*' 99241—fl3S <br /> 'hone #: (.209 ) 368-6175 <br /> \Whorlrrd teprescnlilive of contractor cetlifying through signature below that the tank has been decontaminated In an <br /> +pproved manner as required by Cai EPA.�r J/s%�1 <br /> ;lbnature: "L Title: PRESIDENT <br /> f# !1 !*f4f}4+ ##r! ♦Ra#flRtr!#�rrI RrRIerrR##Els!llrrtrfrRfff#fi#Af!##*ffl###R#f!####fflf*### <br /> I" pip n are free Q �1 sludges aXd h4dr�carbop vapors RD r%jigpVr tai ytzer Steel . <br /> IM,(A UN d • T'o a signed and date by an nu torize rep senin ve o the r atme or , <br /> accepting tank andlor piping. . . <br /> 'acfllty (Name: Schnitzer Steel Products <br /> \ddress: 12000 rolsom Blvd. city: Rancho Cordova zip: 95Z42,�. <br /> 'hone #: ( 916 985-4810 <br /> )ate "rank Received: <br /> ;Ignature: /21, U L Title: <br /> •f#++a14�la*1ai#tilt##ttaaa#lft#!at!#fe.alt###frlsof#!#!#!�f#!f*!!#*!*flffflf!*#f ff####f#*###f####li�#lf# <br /> :N 23 049 (Revised 7-10-92) Page 10 <br />