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SA. )AQUINCOUNTY PUBLIC HEALTH S*qCES <br />ENVIRONNZIEN'TAL HEALTH DrVISION <br />LNIDERGROUND STORAGE TANK DISPOSITION TRACIONG RECORD <br />SECTION I - 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 Environ ental Health Division <br />within 30 days of acceptance of the tank by the disposal or recycling facility. The ptrmft holder is responsible for ensuring that <br />this form is completed and returned. <br />FACILITY NAME: Marsili Property <br />FACILITY ADDRESS: 3212 E. Woodson Rd. <br />tk' -X& <br />TANK ID #39 - TANK SrLE: PREVIOUS TANK CONTENTS: <br />SECTION 2 - To be filled out by tank removal contmctor: <br />Tank Removal Contractor: Jim Thorpe Oil, Inc. <br />Address: P.O. Box 357 City: Lodi, CA <br />zip: 95241-0357 <br />Phone #� <br />.(2019 - 368-6175 Date Tank Removed: - <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contra=: Jim.Tjorpe Oil, Inc. <br />Address: P.O. Box 357 City- Lodi, CA Zip: 95241-0357 <br />Phone #: ( 209) 368-6175 <br />. Tank and * in g"t is�4ree of a'l sigeigg and 01�rocaWbognmy=aors. <br />Authorized representative p' <br />oMontra or c mg through signature W the tank been Brecon in an approved <br />manner as required by Cal EPA <br />Name.- Martin Tbgr Due— <br />,pe Title: Contractor Signature: <br />SECTIOINV4 - To be sighed and dated by an authorized representative of the trea=e=, storap, or disposal facility <br />accepting tank axWor piping. <br />Facility Name: Schnitzer Steel Products <br />Address: 12000 Folsom Blvd., Rancho Cordova, City: CA Zip: 95742 <br />Phone #: ( 916 985-4810 <br />—= <br />Date Twk Received. <br />Narne. Title: Signature - <br />EH 23 046 (Revised 08/13199) Page to <br />