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SANtAQULN COUNTY PUBLIC HEALTH SMICES <br />ENVIRONN1EN'TAL HEALTH D"ION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACING RECORD <br />SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affted with <br />its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br />within 30 d_ays of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br />this forth is completed and returned. <br />FACILITY NAIME: Marsili Property <br />FACILITY ADDRESS. 3212 E. Woodson Rd. <br />TANK ID #39 - TANK SIZE: 2-00- PREVIOUS TANK CONTENTS - <br />SECTION 2 - To be filled out by tank removal contractor: <br />Talk Removal Contractor: Jim Thorpe Oil, Inc. <br />Address: P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone #:(209 ) 368-6175 Daft T,0*R=Q0Ved: <br />SECTION 3 - To be filled out by contractor "decontaminating tank" <br />Tank Decontamination Contractor Jim .Tjorpe Oil, Ina. <br />Address: p.0. Box 357 CW. Lodi, CA zip: 95241-0357 <br />pbm#: 209 ) 368-6175 <br />ank ana is free of all sl s and h rocagognm wax's. <br />9-& ci�ying through signature am the tank been t M an <br />mauve vegg" approved <br />man= as required by Cal EPA. <br />Name- Martin Thorpe Tide: Contractor $nature,, Date <br />SECTION 4 - To be signed and dated by an authorized repreSentadve of the treallnent, storage, or disposal facility <br />accepting tank andJor piping. <br />Facility Narne- <br />Schnitzer Steel. Products <br />Address: 1.2000 Folsom Blvd., Rancho Cordova, City- CA Zip: 95742 <br />Phone #- ( 916 985-4810 <br />Date Tank Received: <br />Name: Tide: Signature: Date <br />EH 23 046 (Revised 08113/99) Pap 10 <br />