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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> rtlttttttstfsstlssttstsffstfs!!f•sstsslflttssstftasssssssstsstfsfsisfsssttssstslstrflsssr•ltst!!t!r!!lrssss <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: ACME Saw and Industrial Supply <br /> FACILITY ADDRESS: 1204 E. Main St. Stockton, CA 95205 <br /> TANK ID #39 - �U����—U Tank Description: 500 gallon gasoline <br /> EPA Site # CAC 000956408 <br /> tttsthest!•tslssts:s•lsssstslsesetsselts!!l:ssf!!tt♦stsr!•tttlt•fsrt!•tsrt•tttffftststfsfssss••lrtrr!!fs•• <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. DBA RICH-MART CONSTR[ICTTON <br /> Address: 351 N. Beckman Rd./ P.O. Box 357 City: odi , CA Zip: 45741-mS7 <br /> Phone #: 2( 09 )_ 368-6175 Date Tank Removed: 2-1 15; 3 <br /> t.tt..tt...f.tttt.......t....ftt.t....t.t....lt.tt:t..tlf.....tat::••.l..•f:l...••••.:....rls..••.•:!•••.! <br /> SECTION 3 - To be filled out by contractor "decontaminating tank% <br /> Tank Decontamination Contractor. JIM THORPE OIL„ INC. DBA RICH MART CONSTRUCTION <br /> Address:_ 351 N. Beckman Rd. / P.O. Box 357 City: Lodi. CA Zip: 95241-0357 <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 required by Cal EPA- <br /> Signature: <br /> PASignature: �. Title: President <br /> tflit♦rttttffffflflfttttifffttRf Rttt!•�lllftflffltftt!•!f•!!r•tlifttfflrtfrfttrflffltfflRt!ltflffttftft•tf <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 /> Address: 12,000 Folsom Blvd. City: Rancho Cordova p: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Signature: Title: <br /> tttttfttttt!!!lNtatfltltttftttttltttfltt!!lfftt N lttttf iflflttltttltlt!lttfttitt!!lttf!!!llftlttlftt•t! <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />