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SAN`-swAQL'Di COL'N=PUBLIC HEALTH SE1 .,,CES <br /> ENVIRONNEL-N-TAL HEALTH DIVISION <br /> LNDERGROUtiD STORAGE TANK DISPOSITION TRACKING RECORD <br /> =z====:z=a====z:..=::a.....r:i.==.... .a.:s=a.=*...a===:a.a..e=z=.e a...t.p.k==.k::=z===tee a.a....===z==.k. . .====a..t----=-z-*........ <br /> SECTION 1 - Psbiic Health Services Environmentai Health Division Tank Tracking Sheet shall accompany each tank afnxed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsfoie for ensnrng that <br /> this form is completed and returned_ <br /> FACILITY NAME: Franks Tire Service Epa : CAC 002127664 <br /> FACILITY ADDR=SS: 5023 Market St . , Linden , CA 95236 <br /> TA.N'K TAINK SIZE: 500 gal . PREVIOUS TANK CONTENTS: leaded gasoline <br /> r <br /> .==z.e.===r==..i.=z===n.=. . .r.=z==:a=====:.....=.a a.. . ..z=....F za..e.:==...•._.====. ...a.==z=ae. ...=.seatz...z==:.w...s==..==s..e. <br /> SECTIO? 3 -To be filled out by tank removal contractor: <br /> i <br /> Tank Removal Contractor: Jim Thorpe Oil Inc. <br /> ,Address: P.O. Box 357 City: Lodi , CA Z 95241-0357 <br /> Phone ;e: ( 2 0 9 ) 3 6 8-617 5 Date Tank Removed: <br /> ........................ <br /> [z=.szzzY.zzzzzzzz=zzzzia <br /> . z=..=='+=zs====a.zas ===zzz.w.=zz=z.. .zzzzz=z <br /> .zzz zYlzzzzaz==.e..zzz.¢z1.z=]..=zzzz <br /> zatz z* f+z <br /> SECTION 3 - Tobe filled out by contractor "decontaminating tank": <br /> Tank Decoruini.natior. Contractor: J Tho--Oe 0i1 , Inc . <br /> Address: <br /> P. 0. Box 357 Cirv: Lod: , CA Zip: 9521-1-035 <br /> pbone r 209 ) 368-6175 <br /> Atilhor.:ed repfeseatative OI COnt�Ctor Ce^ifying i,,lrou_.SS sio mture below that the tank has been decontaminated in an aDGrCye'1 <br /> manner as required by Cal EPA. , P <br /> �J <br /> Name: Richard Thorne Title: <br /> Contractor Sig*tanre: Date O <br /> __ _ __ _ ______________________.........____________------==x=====__________=====r=S eel';,.=,..,.. <br /> T l- fre of all slud es, and nArocarbon npors upgn delivery to Schnits <br /> � �Tl�iv -�o be sipec and dated by an a t or.zed represe tattve o e .:eatrtent. orage, or atspvsai fac try <br /> acc-cpdrig tank and/or piping. <br /> Fac�liry Name: Schnitzer SLeei Product= <br /> Acdress:12000 Folsom Blvd. City: Rancho Cordo-Zt; CA 95742 <br /> P'.:one =: l 9161 985-4810 <br /> Date Tar-k Rezeived: <br /> dame: I�x2J� ��C'firp� Title: Ij" a/1 / Sigrarure: <br /> �Da <br /> zzzzzzizzz... .'zzzzz.f.zzzzzz=zzza.zzzzzzzza...t..'szzzzzzzzzz.t.s.. ....a...... .a.z Y....zzzzzzzz.k.s.at..z z zzzzz=----zzz.zz z.. <br /> i:_. 23 0,16 (Rzvised 10/i9i98) Page 10 <br />