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SAN JOA`6IN COUNTY PUBLIC HEALTH SERVIear6 <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />•+ia+#+♦al++#!!##+a+##}!#fr#♦♦r#a+laf►aa##r#rfarrf##af#!i#!r#a}#►frr#r#rf#lfaff►ffffffflfffflfffffffffff►ff <br />SF.(`11ON I - Public Health Services Environmental health Division Tank Tracking Sheet shall accompany each lank affixed <br />with its site Identification number. The Tank Tracking Sheet is to be returned to Public flealth Services Environmental Health <br />Divlsinn within_3Q.days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for <br />ensuring that this form Is completed and returned. <br />rACILITY NAME: Ralnt tQ n(ar EPA 11 CAC nnn744 <br />rACILITY ADDRESS: 2122 S. Airport Way, Stockton, CA 95206 <br />12 000 gals PREVIOUS TANK CONTENTS: gasoline <br />TANK IU A39 - TANK SIZE: r <br />♦♦aa.aaaaa♦!+rl+#+aa+♦!al+++l++fl+#!!##++##+lirlf+#+!lraf#+#fr!♦+►a+#fflf#ar###!#f#ffaflff#IffflffffMff#ff <br />SF,I MON 2 -'to be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thorpe Oil luc. <br />Addtcss: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA _zip: 95241-0357 <br />Phone IF: ( 20 ) 368-6175 Date Tank Removed: <br />+aa+a+ai+++al++lfaa++##!##a#!#lr+a!#►f#rair##fra#►frf#+##rrffr#raa#f##a!►#!#♦++##!+♦f#aff##aflra4a#af##fafrf <br />SECTION 3 - To be filled out by contractor "decontaminating lank": <br />Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br />Addreaa- 351 N. Beckman Rd./P.O. Box 357 City; Lodi, CA zip:95241.-0357 <br />Phone A:( 209 ) 368-61 <br />Amhnrized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br />tnnnner ns required by Cal EPA. <br />Nnme <br />Title: Signature: . Date <br />a t AW S "f #ree "0#" a"1'#+s1 u8gers" an <br />SECT ION 4 - To be signed and dated by an <br />accepting tank and/or piping. <br />racility Name: Schnitzer Steel Products <br />Address: <br />Phone p• ( 916 <br />12000 Folsom Blvd. <br />Date Tank Received: <br />Name: <br />985-4810 <br />Rancho Cordova, CA <br />City: Zip: 95742 <br />Title: Signature: <br />++++#a##i+++##f#r#aa+#+af#rra++#1+r+rl+!#arfr##►#►##arra+►#+++Fara#++++lra♦♦+++++##r#+ir++rf##♦#fraar##ar <br />Ell 23 046 (Revised MUM) Page 10 <br />