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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIM6 <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />+i+#+++#+##+#++f##4++#!f4#!##!+#t!t#+r#+fi+f+#!+##f+#fit##fi###4f#!###fi##4#!r##1!!#►#t#t!!!t!##!#►4##!##!##!t! <br />SECTION I - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed <br />with its site identification 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 holder is responsible for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: Rat ph Is Market E.P.A. li CAC nn07 -'816 <br />FACILITY ADDRESS: 2122 S. Airport Way, Stockton, CA 95206 <br />TANK ID N39 - <br />TANK SIZE: 12,000 gallOMEVIOUS TANK CONTENTS: gasoline <br />i+iiaiaai+###•###++++##fir++fif+#f+r##!##fi+#+lrfil++##fi♦#fif#+#+#t+#fi++ffrr##!#+###ttt###t!!t##r#r+#t!##!t#!#!# <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thor e Oil Inc. <br />Address: 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone S: ( 209 ) 368-6175 Date Tank Removed: <br />++#+asi#i+#a+++++lf##!!#»»!!+#!l++fiif##!+#!#!r#!+##rrtfi+#####•r#r###f+tfi#!#+r!!#!rs#!!#!!#!####!#######!!#! <br />SECTION 3 - To be filled out by contractor "decontaminating tank": <br />Tank Decontamination Contractor: Jim Thorpe Oil, Inc. <br />Add,,ev 351 N. Beckman Rd./P.O. Box 357 City: Lodi, CA Zip:95241-0357 <br />Phone N: ( 209 ) <br />Anthnrizrd 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: <br />Title: <br />'Yam R' 1 s of free i0#a'Yf #sl udtge's" an <br />SECTION 4 - To be signed and dated by an <br />accepting tank and/or piping. <br />Facility Name: Schnitzer Steel Products <br />Address: 12000 Folsom Blvd. <br />Phone 9: ( 916 ) 985-4810 <br />Date Tank Received: <br />Name: <br />Rancho Cordova, CA <br />City: Zip: 95742 <br />Title: Signature: Date <br />+++++++++#+##r+fi#fi#++rrrfir+r++#++##+l++#r+rf#♦+t##fi##++##r##+t++++#rfi####t++++++++++++++#+++++##+++++++++ <br />Ell 23 046 (Revised 9/11/96) Page 10 <br />