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<br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD
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<br /> r,CHUN t - Public Health Services Tracking Sheet will accompany each tank affixed with Its site Identification number.
<br /> Lie Tracking Sheet Is to be returned to Public Health Services xlihln 30 dais of acceptance of the tank by the dtsposal or
<br /> tecyciing facility. 'Ilse permit holder Is responsible for ensuring that this form Is completed and returned.
<br /> 1CiLI-1Y NAME: Concrete Inc. _ _EVA Site _UCl1C o0lj 983656
<br /> i - -
<br /> C'ACILI'I-Y ADDRM: 749 S. Stanisiaus St. Stockton, CA 95206
<br /> ;,.' NK 1D #39 - -0 y Tank Ucsctiptiun: 5,000 Gallo[ Diesel Gasoline Waste Oil
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<br /> :CfI0M 2 - To be filled out by tank removal contractor:
<br /> 'rank Rcinoval Contractor: Jini Thorpe 011 Inc. DBA fiicti-Mart Construction
<br /> !dress: .3'j I N. Brzc:lunari ltd./ P.U. Wx 35' Clly: _Lvdl, CA _ ZIp:�95241-0357
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<br /> Phone #- 2Ux( ) 1 162-hW l Date Tank Removed: 311
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<br /> St;CUION 3 - To be filled out-by contractor 'deeonlarnInaling tank':
<br /> -''ink Decontamination Contractor:__Jini'1'liorpe 011rD13A Riclr.Mart Construction
<br /> �Vdress: 351 N. Peckinarr lid-/ 1'.0. Bux 357 City: Lodl, CA _ Zip: 95241-0357
<br /> lone 2093 462-4581
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<br /> Authorized representative of contractor certifying through signature below► that the tank has been decontaminated In an
<br /> proved manner as required by Cal EPA.
<br /> '' & P•
<br /> Signature: Title: /.0 e
<br /> .64060041..........6•.►.0 s1,.......1...411,111,1,1.•1,.•..!•..•••.•...•...1,.•.•.11..1•of* 600
<br /> ;(:VION 4 - To be signed and dated by an authorlLed representative of the treatment, storage, or disposal fad[Ity
<br /> aces t k nc]``nr Ipin
<br /> 'ank is free �i S t s udge� art�l tiydrocarUon vapors upon delivery to Schnitzer Steel .
<br /> s,..cility Name: SclrrilLzer Steel Vr•oducts
<br /> ddress: 12000 Colscxn 131vd. City:llanelio Cordova 7jp: .95742
<br /> done �►: •9(16 x305--4810
<br /> its Tank Received:
<br /> Signature: Title:
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<br /> Fu 23 049 (Revised T-16-92) Paye 10 r.
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