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I� <br /> i <br /> j <br /> i <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <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 J•H. Simpson Company EPA #CAC 001189064 <br /> i <br /> FACILITY ADDRESS: 4025 Coronado, Stockton, CA 95204 <br /> TANK ID #39 - Tank Description: 2,000 gallon ul gas <br /> i SECTION 2 - To be tilled out by tank removal contractor: <br /> I Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 351 N. SE MAN RD. / P.O. BOX 357 Clty: LODI :Zip: 95241-0357 <br /> Phone #: (209 ) 368-6175 Date Tank Removed: <br /> SlsMON 3 -To be filled out by contractor 'decontaminating tank": <br /> Tank Decontamination Contractor JIM TIIORPE OIL, INC <br /> Address: P.O. BOX 357 City: LODI Zip: 99241_n1s7 <br /> i <br /> Phone #: (209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as re fired by Cal EPA. <br /> Signature: Title: - PRESIDENT <br /> SEC'CIUN p p o'beastgnedrand dated by t nli�iitorizeg rd�ept .sderitga �o thea�r i�tt oisTTgti�F sp al CIIIIc-hnSteel <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City. Rancho Cordova Zip: 95742 <br /> Phone #: ( 916 985-4810) <br /> Date Tank-•Received: <br /> Signature: Title: <br /> ER 23 049 (Revised 7-10-92) Page 10 <br />