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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD
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<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 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: Victor Foppiano EPA Site #CAC 000 900512
<br /> FACILITY ADDRESS: 8300 Helen Lane, Stockton, CA 95212
<br /> TANK ID #39 - EXEMPT AG TANK Tank Description: 350 Gallon--61iC Gasolitl�/ 1
<br /> SECTION 2 - 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 Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357
<br /> Phone #: (209 ) 462-4581 Date Tank Removed: 4/16/94
<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 Rd./ P.O. Box 35'/ 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: /Ji � Title: Vice-President
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<br /> SECTION 4 -To be�siignted and ddlated by an authorized representative of the treatment, storage, or disposal facility
<br /> Tank is freeR�tf � I s�udgeg'paA hydrocarbon vapors upon delivery to Schnitzer Steel .
<br /> Facility Name: Schnitzer SLeel Products
<br /> Address: 12000 Folsom Blvd. City:Rancho Cordova Zip: 95742
<br /> Phone #: 9( 16 ) 985N-48 10
<br /> Date Tank Received:
<br /> Signature: Title:
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<br /> EH 23 049 (Revised 7-10-92) Page 10
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