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SAN JOAQUIN COUN`T'Y PUBLIC IIiEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> I ` UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SEC'T'ION I - Public Health Services Environmental Health Division Tani. Tracking Sheet shall accompany each tank affixed <br /> with its site identificationnumber. The Tank Tracking Sheet is to be reurritied to Public Health Services Environmental Health <br /> 1)ivisinn within 30 days of acceptance of the tank by the disposal or recycling facility. The perrr►it holder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILI'fy NAME: Tri Star Hordes, LLC E.P.A. # CAC 001166584 <br /> FArII..ITY ADDRESS: 1325 N. Corral Hallow Rd. , 'Tracy, CA 95376 <br /> P <br /> r TANK ID #39 TANK SIZE: 300 PREVIOUS TANK CONTENTS: ld gasoline <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil 111C. <br /> Lodi cA zip: 95241-0357 <br /> Address: 351 N. Beckiiiati Rd./P.U. Box 357 City: , ^ <br /> Phone #: ( 2�09 ) 368--61'75 Date Tank Removed: d- <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jitn Thorpe Oil, lnc. <br /> Address: 351 N. Beckman lid./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized tepresentative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> minner as required by Cal EPA. <br /> r <br /> + Narne: Title: !' Signature: Date <br /> t <br /> T l�c*ai *�F "$ " ti* 'l`+ *i fs *R i "�C ti'dry* !`a dd 71 <br /> f�Ze'� *1,tee'Y" <br /> SECTION 4 - To be signed and dated by an authorized representative he treatment, storage, or disposal facility <br /> accepting tank and/or piping- <br /> Facility Name: Sclirdtzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 F'olsorn Blvd. City: Zip: 95742 <br /> Phone #: ( 9 16 1985-11810 <br /> F. Date Tank Received: <br /> Narne: ilerj Signature: Date <br /> `/F{F� «####r##+*�*f***#+*M***/e/Ih**#�**#***•M***+k#**##****�**•+k#**#A+***##*************#h Me#*****�****#**!iM***f** <br /> Ell 23 046 (Revised 9/11/96) Page 10 <br /> 1 <br />