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SAIROAQUL COliN-TY PLBLIC HEALTH VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> L-NDERGROL-N-D STORAGE TANK DISPOSITION TRACKL,iG RECORD <br /> MMMMMMMMxMMMMMMMMMMMMMMMMM%MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM%�MMsti[�[%MMMMMMMMxMMMMx%MMMMxMMxMMxMMM*�%xxxx%M <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days or acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensurinz that <br /> this form is compieted and returned. <br /> FACILITY NA.IE: HUNTER HARIS EPA SITE #CAC 002570841 <br /> FACILITY ADDRESS: 17112 N. Hwy 88, Lodi , CA 95240 <br /> TANK ID#3V EXEMPT TANK SIZE: 500 PREVIOUS TANK CONTENTS: gasoline <br /> #MMytMMMMMMM �M�w:%��******����-����*M*K*M%**MMMMk**MMM**k*M%MMMkM MM*MMMM*R RMMxa�cMM*MMMMM�t*aM�tM*%MMxzx xM — <br /> SECTION 2-To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 677 E. Lockeford St. , P. 0. Box 357 City: Lodi . CA—Zip:-95241-0357 <br /> Phone#: (209 ) 368-6175 Date Tank Removed: <br /> MMMkMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMxMMMMMMMMMMMMMMMMMMMMM%M%MMMMMMMMMMMMMxM%%xMMMMMMxxMMMMMMMMMMxxxxxM <br /> SECTION 3 -To be tilled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM TH 0 RP E OIL INC. <br /> Address: 677 E. Lockeford St. , P- 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone n: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that he tank has been decontaminated in an approved , <br /> manner as required by Cal EPA. <br /> Name:jWgjti-Tide: �� Signature: Date U <br /> M MMMM* M*MM*M M MM %MMMxMMMMMM MMkMMxMMMMMMMMMMMMMMMMMMMM=xieM%MMMMMMMMMMMMMMxMMMM%MMxMMMMMMxMMMMxkxxM <br /> T*an' c i s free o a s udges anc h droc rbon va yrs �on�d ate S*r ;F�Q� praci§i�el <br /> SECTION 4 -To be signed and dated by an au horize represen the o e ea <br /> accepting tank and/or piping. <br /> Faciliry Name: Schnitzer Steel Products <br /> Rancho Cordova , CA <br /> Address: 12000 Folsom Blvd. City- Zip: 95742 <br /> Phone#: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Mal 7, i, le: I QbW A - Si ature: Date/(3 <br /> Name: r f <br /> MxxxMxxMMMMxM%1[xM%MMiiMMMMYMxM%xxxMMMxMx%MMMM%MMMxMxMMMMMMMMMMM�xxMMMMMMMMMxMx%MMMMxxxxxa<xxM:K%xMxxxxzx:xx <br /> EH 1-3 046 (Revised 08/13/99) Page 10 <br />