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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />!!!!!!!!!!!!fflft#fft!•!f!#!!lRtttf•!#tf•f•tit!!!!#tft#•t#ff!•t!!!!!!f!!#!!!!!!!!!#!!!t!•!!t!f!t!!!t!!!!!!t <br />SECTION t - 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 da-ys 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: West Lane Fuels EPA Site #CAC 000 9 JIZ z --'"e---) <br />FACILITY ADDRESS: 3300 West Lane Stockton, CA 95204 <br />TANK 1D #39 - 12-x`1 -©`/ Tank <br />550 Gallon D <br />#♦!t!!!H •!!#t##ttfRt♦#•!##ft♦!•f#ttft•R#!•tit!#•••!•!•fttttlttlf!•tilt!!##!}!!•!!!N!#!!!!!!!#t!!t##ft!!#! <br />SECTION t - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thorpe Oil, Inc DBA Rich -Mart Construction <br />Address: 351 N. Beckman Pd./ 11.0. Box 357 City: Lodi, CA, ! Zip: 95241-0357 <br />Phone #:(209 ) 462-4581 Date Tank Removed: <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: Jim Thorpe Oil,DBA Rich -Mart Construction <br />Address: 351 N. Beckman Pd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone #:( 209) 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 />Signature: <br />Title: V, �. <br />!!I#l•!!!!!####!t!t•♦•till/lttl#!•!!•f•#t#R#!•#f#•!#!#!•tR!!##ftltt•#t!!lilt#t!••tt!!tt•!!•!f!f!t#!t!#!!}•f <br />SECTION 4 - To be signed and ddd��ated by an authorized representative of the treatment, storage, or disposal facility <br />Tank is freee�it �ajs�udge�i M hydrocarbon vapors upon delivery to Schnitzer Steel. <br />Facility Name: <br />Schnitzer Steel Products <br />Address: 12000 Folsan Blvd. City:Rancho Cordova Zip: 95742 <br />Phone #: ( 916 ) 985-4810 <br />Date Tank Received: <br />Title: <br />1.l....•...•••!!R1#t!•!•f�•f#!:•.lit/t�Rf••fit•#t##•!ftltlft#!•tf!!ft##!!!}tf!!•f!t#f!f•#t!#!!t!!!•ft!!#• <br />ER 23 049 (Revised 7-10-92) Page 10 <br />