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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENY[RONWNTAL HEALTH DMSION <br /> UNDERGROUND STORAGE TANK DISPOS ON TRACKING RECORD <br /> ####i##iF#####vir>M####/r#♦Jr######***N#v1############***#*Ir+k##*ale## #####*I*##*###########*######111##**########�1### <br /> SECTION I - Public Health Services Environmental Health Division TarflL Tracking Sheet shall accompany each tank affixed <br /> with its site identification number. The Tank Tracking Sheet is to be rete ed to public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br /> ensuring that this form is completed and returned- <br /> FACILITY NAME: Tri. Star Homes, LLC E.P.A. # CAC 001166584 <br /> FACILITY ADDRESS: 1325 N. Corral Hallow Rd. , Tracy, CA 95376 <br /> TANK ID #39 - 1 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 Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 ity: Lodi, CA ZIp: 95241-0357 <br /> Phone lf: { 2_ 09 ) 368-6175 Date Tank Removed: a1- <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 icy: Lodi, CA Zip:95241-0357 <br /> Phone b: ( 209 ) 368--6175 <br /> Authorized representative of contractor certifying through signature below hat the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Sign tore: A Date <br /> " i*' ts"* i�Y'"db*d► * � ## i #* 5 �'►jr* 'o'" crni zer* eee'`**�*##*# <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment,storage, or disposal facility <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. City: Zip: 95742 <br /> Phone #-. ( 916 ? 985-4810 <br /> Date Tank Received: <br /> Name: �ng AL <br /> ik Signature: Date <br /> •####*#i.w k r it�###i##ildr#r rY+Mw#+Mir,Ml.#Ysv#e#####f####**+k#####�#**#####*i+Y leA,!#M+YMr##+h#MhM#fM###kkM#*#iR###+kRoR ale#### <br /> EH 23 046 (Revised 9111/96) Page 10 <br /> F <br />