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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: ACME Saw and Industrial Supply <br /> FACILITY ADDRESS: 1204 E. Main St. Stockton, CA 95205 <br /> TANK ID #39- � 0 U /�.� 212-Tank Description: 500 gallon gasoline <br /> =P;Site#C ; 000956408 <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor. JIM THORPE OIL, INC-_ DBA RICH MART rnNeTi?TrCmTnn, <br /> Address: 351 N. Beckman Rd./---P.O. Box 357 City: LQUi CA_Zip 9,?41-n-1S7 <br /> Phone #: 2( 09 )_368-6175 Date Tank Removed: Cf/ol 7r'3 <br /> =ltsiilttsisififiititttsilfi«ffft!lfitiilitiisslf!!ltitiils=«siss==:i=ii«ltsif«isiff==l=l=lsilifti«list«!s! <br /> SECTION 3 - To be filled out by contractor "decontaminating tank•: <br /> Tank Decontamination Contractor. JIM THORPE OILINC. 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: Title: President <br /> s=sssssfsslfssssssfsffefsfssssssfssisssslssfsssssstssssffsissssssfistslssfsf=sss==s==ss=fs*ss**ff!lsssssfls <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: Zip:Rancho Cordova 95742 <br /> Phone #: 9( 16 ) 985-4810 <br /> Date Tank Received: �/ 9 <br /> Signature: Title: <br /> titiiiifltifi!!i!!i!!tillfsits==i!!!=ftiiiliiii!#iiiiif!!iilifitsffssssii==i=ii=ii=iiiisfi!!s!!lstssi#si <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />