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V <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •rr•ssrrrsrrttttfrrftrslrstrsstrrtstftsrrsssrrsssrsrrsttrfssrssrr»•rrrtfttrssrlsstsssslst!lttstrrrsssstts <br /> r SEMON I - Public Health Services Tracking Sheet will accompany each tank afIIxed with Its site identification number. <br /> The Tracking Sheet Is to be returned to Public Health Services with€n 39 days of acceptance of the tank by the disposal or <br /> ecycling facility. The permit holder Is responsible for ensuring that this form Is completed and returned. <br /> FACILITY NAME: Concrete Inc. CPA Site 4 CAC 0 ©983656 . <br /> FACILITY ADDRESS: 749 S. Stanislaus St. Stockton, CA 95206 <br /> TANK ID #39 - 5U Wr-y-�- Tank Description: 5,000 . Gallor Diesel Gasoline Waste Oil <br /> L.rrrrrrt•!Rr!!!t•tlilrt•Rltrrrrrtflttrsltlttfftfls!!t!•!ltrftlrttrrtlrlstrf!ltttlttrffrtlfrrrlrtlt!!!!!#tft _ <br /> SECI'ION 2 - To be fiIIed out by tank removal contractor: <br /> ank Removal Contractor: Jim Thur e Oil, Inc. DBA Rich-Mart Construction <br /> Address: 351 N. Beckman Rd./ P.O. Box 357 City: Lodi, CA Zig: 95241-035,7-,_-_ <br /> hone #: 20( -9 ) 462-4581 Date Tank Removed: <br /> ••,•frr•rrrr•••rssrtrs!!ir!lttrrrtsfsssslslrrtttsstrsssls!!!!tlrsrsrfrrsst!!lssslslssssr!!st!!tr!!s!s!flsts <br /> ;ECTION 3 - To be filled out by contractor 'deoontamInating tank <br /> +-tank Decontamination Contractor: Jim Thorpe Oil DBA Rich-Mart Construction <br /> Iddress: 351 N. Beckman Rd./ P.O. Box 357 City: _Lodi, CA Zip: 95241-0357 <br /> Phone #: L209 462-4581 <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 /> ignature:_ Title: C d. <br /> rrrrrrrts•srsrrrsfrlstrrsrfssrtlrsrlrrtfssssrs!lrrrfrrsssslts!!!rlrrssrssstrsrrsstlsrr•srrrsarrsssssssrtrrs <br /> E('1'ION 4 - To be signed and ddlated by an authorized representative of the treatment, storage, or disposal facility <br /> L'Tank is frecece sIudge�lpan� hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> *Address: 12000 Folsom Blvd. City:Raricho Cordova Zip; 95742 <br /> hone #: C916 .) 985-4810 <br /> Date Tank Re ived: (� <br /> L.ignature: Title: <br /> �rrrrssrt•ter+rrrrsrr'tir•rrfrrsssrrrrrrrrfrrrrr•rrrrrssrfr�rrrrrrrrrrrrsrrrrrrrrtrsrrrrrsrrssrrrrstrssts <br /> L-1 23 049 (Revised 7-10-92) Pape 10 <br /> V ' <br />