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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />SECTION 1 - 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: LODI LIQUOR FOOD STORE EPA Site #CAC 001060288 <br />FACILITY ADDRESS: 1225 W Lockeford Street, Lodi , CA 95240 <br />TANK ID # Tank Description: 1 - 350 gallon waste oil tank <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: JIM THORPE OIL, INC. <br />Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODT, Zip:�5241-0357 <br />Phone #: ( 20— 9 ) 368-6175 Date Tank Removed: July 18 , 1996 <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: JIM THORPE OIL INC <br />Address: P.O. BOX 357 City: LODI Zip: q -)?41 -Q -1F)7 <br />Phone #: ( 2_09 ) 368-6175 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as requir5O)by Cal EPA. <br />Signal <br />d i " Illfll lyii <br />#r ** *rair,�+*rs+*++ +*+*** **+Vy <br />an are ptpin�are Tree Q slud�es agd h�,ydroc rbop vapors u�o d �i��r �� hh zer Steel <br />SECTION 4 - To a signed and date an aut iorize rep esentat�ve o the reatme oraFg , disp alct� <br />accepting tank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />Address: <br />Phone #: ( 916 <br />12000 Folsom Blvd. city: Rancho Cordova Zip: 95742 <br />Date Tank Received: <br />Signature: <br />985-4810 <br />EN 23 049 (Revised 7-10-92) Page 10 <br />Title: <br />