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1 <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> !litetkffl#•Rff#ftRRlffflf!!flfff###!falf#!f##Rf11!#fftit#tf#fflt#is#stilffiiifif#f1lklffR#fRftf###fR#isiiR <br /> ' ECTION l - 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: Riverside Cenment Co. <br /> FACILITY ADDRESS- Q 2825 W Wasliln tori St. Stockton Ca. <br /> TANK ID #39 - Z -DI Tank Description- 1 ,000 gal. un ded gasoline <br /> GPA # CAcaog <br />' •!t##•##ta!##!#RRR#a!#!tf#f#!#!1###t1lR#!!1#t##ltttf 11##!flRt#! # #s#11R#!##tilt#1lf RR#!#lilt!#!ft#R## <br /> SECTION l - To be filled out by tank removal contractor- <br /> Tank Removal Contractor — <br /> Address-_ -351 �N N. Becknmi lid./P.Q. Bx_-157 City: Zip: 95241-0397 <br /> hone #• (20q_ _ _) -368-6179 Date Tank Removed <br /> ♦!�!!1!#!a#Illi111111111111l1111111l1f1if1•!t1#l111Rf#!!!11l111####i#iia#1#!!!lflilil!###R1#f1l1i#1!!fflill <br />' SEC I ION 3 - To be filled out by contractor "decontaminating tank"- <br /> Tank Decontamination Contractor ilio— 0Inc, Ba — art ConstrjAction <br /> Address,. .351 N. bf:j;ktnarj lid. / R1cIr--Mart Coristructior)City• Lodi, ZIp 95241--0357 _. <br /> Phone #: ( 2Qg368-6115 <br /> tAuthorized 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. ��% Title Contractor <br />' Tank is free of all sludges and hydrocarbon vapors upon delivery to Schnitzer Steel <br /> •#1tto if!#Rfliiitataiffi!#•#ff!#tt#att#i!a#f!f####f###t#lftttklitiffatli#fflRslfttt!!i#aa if Rlktiiif###!1#1 <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br />' accepting tank and/or piping <br /> Facility Name- Sclinitzer Steel Products <br /> Address 12000 Folsom Blvd. City Rancho_Cordova Zip: 95742 <br /> Phone #. (_9 16 } 135-4810 <br /> Date Tank Received <br /> Ignature• Title- <br /> Ex 23 049 (Revised 7-10-92) Pape 10 <br />