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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />!!•!e!!!!•!!f}fttfttt!!♦t!!!ft!•f•#!!f•t•!!•ttlt••stttlt!!••ttt#tt!•f#•#t!t!•f##!•f!!f#•f•!lffflf!!f#!•ts•# <br />SECTION I - 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 days 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 <br />FACILITY ADDRESS: <br />3300 West Lane Stockton, CA 95204 <br />TANK ID #39 - I -L69 - D -f Tank Descri <br />550 Gallon D <br />SCCI'ION Z - To be tilled out by tank removal contractor: <br />Tank Removal Contractor: Jini Thorpe Oil, Inc DBA Rich -Mart Construction <br />Address: 351 N. Beckman fid./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone #:(209 ) 462-4581 Date Tank Removed; <br />SE(MON 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: Jini 'Thorpe Oil,DBA Rich -Mart Construction <br />Address: 351 M. Beckniai i fid . / 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: <br />eeeeeele!!!!}!!!ss!}!!!!!!!s}!!}!!e!}}}}s}!!!!!}!ss!}!s}slss!•}ts!!lsass(sat!•ss•stf!!s•!!•s•sstt••tss••!•t <br />SM-1'I0N 4 - To be signed and dddt�ated by an authorized representative of the treatment, storage, or disposal faci8ty <br />Tank is free bt s�udge0pa'A hydrocarbon vapors upon delivery to Schnitzer Steel. <br />Facility Name: Schnitzer Steel Products <br />Address: 12000 Folsotn Blvd. City:Rancho Cordova Zip: 95742 <br />Phone #: 9( 16 ) 985-4810 <br />Date Tank Received: <br />Signature: Title: <br />♦},seres}}}e!!!}e!e!!!t}}!ts}!}!!!!!!}}ltes}#!}!•!!!!}t•}!e#!t•t!!!•!!!!!#!#!•!#!ts!•st#ss#•t!#s•ss!•ss• <br />ER 23 049 (Revised 7-10-92) Page 10 <br />