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j <br /> SAN A1&V4 COUN'T'Y PUiiLIC HEALTII SERN�*.& <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION 'TRACKING RECORD <br /> iiiiaiaiiiiiaar#aaraawa+!#+►ria#rat!*wlw+4wtraai•#atwtiiw!*#!t*iii'1##ti*r**t*!it*#i*1*t#i#�#i#l+Mi4i*4ilN#itt <br /> STt"1it)N 1 - Pnhtic fiealth Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its sitr identification number. The Tank Tracking Sheet is to he returned to Public Health Services Environmental Health <br /> nivision within 30 days of acceptance of the tank by the disposal or recycling facility. The permit bolder is responsible for <br /> ensuring_ that this form is completed and returned. <br /> FACILITY NAME: Carl ' s Jr. Distribution Center E.F.A. # CAC 001174296 <br /> 800 Mellon St. , Manteca, CA 95337 <br /> rncmrt-Y ADDRESS:: LLL <br /> TANK 11) 139 - l�d �`0 r TANK SiZE:/_-0 0- PREVIOUS TANK CONTENTS: Diesel <br /> aaaaaaaaaaa.aariraaaa••aarrrrr#rarwrrraratarrateaat#riaaaraa*rwwa*r!arra!!*a!a!!#*!#i*i*iiiiitiiiiM+Rttliit! <br /> SF,(.1'ION 2 - To be rifled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil Inc. <br /> Address: 351 N Beckman Rd /P.O. Box 357 _— city: Lodi, CA Zip: 95241-0357 <br /> Phone +1: ( 209 ) 365-617 5 Date Tank Removed: 11- - <br /> ...aaaa.aaaaaaaaaaa aaaaaaaaairaraaaraaarifaaaraaaaraaaaaaaarVaraaraataaiairirrriwrwrrit►r!i!t!!ii*i*iiii!*# <br /> SECTION 3 - To be rifled out by contractor "decontaminating tank": <br /> Tank T)ccomamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip:95241.-0357 <br /> phone A: ( 209 ) 368-6175 <br /> Authorizrtl representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: #4rttty' oK-yt Title: VIP SigAttl Date <br /> a1'ank's'firee'o 'aYt"s1 u*j *s ana1r�,y a*)ar5n`vapor's upon`*de I i ver#*rho*95hni <br /> SEC17(Nd 4 - To be signed and dated by an autfiorize� representattve of the treatment, stvage, or cdisposal acilhry <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folson Blvd. City: Zip: 95742 <br /> Phone 11: ( 916 ) 985-4810 <br /> Date Tank Receiv(ed:r ' 2 /i-i P� <br /> f lanrc: ��O t'-i erro Tithe: Signature: d Date <br /> ♦aaaaaar.MaiaraiiiiraralarairaaairirritRw4rrtlrI.i.aii+Yarrrtaaaairaaaa*iwwtart*#**r*r*icer#!*#i4*#*iii#*!*!t*t** <br /> Ell 23 016 (Revised 9/11/06). Page 10 <br /> J <br />