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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •.•••.••••••.•••••••••rr••••••rrr•r•••••••rr••••r•••••r•••••••••r•••r••••••••••••Hrrs••i H••i N•••.•.•.•.• <br /> Sh:Ct'ION L - Public Hearth Services Tracking Sheet will atxx)mpany each tank affixed with its site Identification number. <br /> of acceptance of the lank by the disposal or <br /> The Tracking Sheet is to he returned to Public Health Services within 30 days <br /> recycling facility. The permit holder Is responsible for ensuring that this form Is completed and returned. <br /> FACILITY NAME: Lloyd Gums EFA Site 17CAC 000883888 <br /> FACILITY ADDRESS: 303 S. Cherokee Ln Lodi, CA 95240 <br /> TANK ID #39 - Tank Description: Product Lines Gallon Diesel Gasoline Waste Oil <br /> 9LCl'ION I - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim 'Thor 1e Oil 2 Inc. DOA Rich-Mart Construction <br /> Address: 351 N. Beckman lid./ P.O. Dux 357 City: Lodi, CA Zip: 95241-0351 <br /> Phone #: (209 ) 462-4581 Date Tank Removed: <br /> Sr�CfION 3 - To be Tilled out by contractor "decontaminating tank": <br /> 'Tank Decontamination Contractor: Jim 'lhorpe Oil,DBA Rich-Mart Construction <br /> Address: 3 )1 N. Beckman Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: 1 209) 462-h581 <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: Title: <br /> SECT ION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> acceVfnR jyk Ind/9r plpin¢, y n n Y <br /> Tank, is free U(f a s zed es anU h drocarbon vapors upon deliver to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Polsotn Blvd. Cily:Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 1 965-4810 <br /> Dale Tank Received: <br /> Signature: Title: <br /> FR 23 049 (Revised 7-10-92) Cage 10 <br />