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1 i I I I UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD ••••••••••••t•••t•••••••t•tN•••tt•N•tt•ti•NtttRttt•ttt•tt•t•t•Ntttttttttttt•tt••ttttttttttttttttt•ttsss SECTION I - Public Health Services Tracking Sheet will accompany each tank affixed with its site Identification number. Ilia Tracking Sheet is to be returned to Public Health Services within,}Q data of acceptance of the lank by the disposal or recycling facility. The permit holder Is responsible for ensuring that this form Is completed and returned. FACILITY NAME: J.H. Simpson Company EPA #CAC 001189064 FACILCI'Y ADDRESS: 4025 Coronado, Stockton, CA 95204 TANK ID *39 - Tank Description: 2,000 gallon ul gas ' t••s•t••s•••••••••••••••••••••s•s••••••••t♦•ss••••ss•s•••••sssst•••••••••s•sts•tttstttsst•••••tsts•••••stst SECTION 1 -To be filled out by tank removal contractor: Tank Removal Contractor: JIM T[IORPE OIL, INC. Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODI Zip: 95241-0357 Phone #: (209 ) 368-6175 Date Tank Removed: t �?,UUION 3 -To be filled out by contractor "decontaminating lank": Tank Decontamination Contractor: JIM TIIOPPE OIL, INC. Address: P.O. BOX 357 City: LODI Zip: 95241-0157 Phone #: (209 ) 368-6175 Authori.7.cd representative of contractor certifying through signature below that the tank has been decontaminated in an approved manner as re Bred by Cal EPA. Signature: Title: PRF-91DFNT is •• •. To Vs•• •• l �is�C10pPn% are sign s and dated y 8n1a AioNzed�tepi'esde[i�afiwe n pg to , Steel . accepting tank and/or piping. Facility Name: Schnitzer Steel Products Address: 12000 Folsom Blvd, city: Rancho Cordova Zip: 95742 Phone #: 916 ) 985-4810 Date Tank�Received: RIgnsture: Title: `�Ti•s•••••tt•tt••t•t•••••••t ••••t.••t• •tt•t••ttt�t••••t•tt•.•.tt•••ttttt••tt•tt•.tt•tt•tttt••.tttt••t• EN 23 049 Mvised 7-10-92) Page 10