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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SEC'T'ION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br /> with its site identi rication number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health <br /> Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit bolder is responsible for <br /> ensuring that this form is completed and returned. <br /> FACILITY NAME: MRS. DAN BORE LL I E.P.A. # CAc <br /> FACILITY ADDRESS: 5311 N. Jack Tone Road, Stockton, CA 95215 <br /> TANK ID N39 - N/A TANK SIZE: 250 PREVIOUS TANK CONTENTS: gasoline, <br /> SECTION 2 - To be filled out by tank removal contractor: <br /> 'rank Removal Contractor: Jim Thorpe Oil, Inc <br /> Address: 351 N Beckman Rd./P.O. Box 357 City: Lodi, CA zip: 95241-0357 <br /> Phone a: ( 20_) 368-6175 Date Tank Removed: <br /> SECTION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br /> Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA zip:95241-0357 <br /> Phone #: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name: i Title: Signature: <br /> *+ *++*+ +***** +* ** ** *+*++** * ** +****+ +*****+*****+****** * ****** ******* ******&4,--�/—.A� <br /> **** ******* <br /> Ia*n*k is free o* a*f s'�uc*ges an shy rocarpon vapors upon d*ever o Sc5hn't��r,'�tee . <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, stotage, or ispos actl ty <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> iz Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. City: ZIP: 95742 <br /> Phone #: ( 916 ) 985-4810 <br /> Date Tank Received: 2- f <br /> NamcloAre m Title: Signature: Date <br /> Eli 23 046 (Revised 9/11/96) Page 10 <br /> _ a <br />