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SAN JOAQUL1t COUNTY PLBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DMSION UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD #####M}M}##M}##t#tkMM#M#MMM####MMMM##MM####MMMM#M#M##}*#MM}#MM}#MMM###M}M#MMMM###MMMMMM**####MM##MMMM#M#**M SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. FACILITYNAME: Tony Jockovich Trust FACILITY ADDRESS: 767 N. Alpine Rd. , Stockton, CA 95215 TANK I #39- TANK SIZE: 350 PREVIOUS TANK CONTENTS: Unleaded gas -. __ k#MkM}}}kk+M#kMMM}}kM}M##M}MM##iMiltlLiILMM###MMM###MM#kMM#MMM#k}MMMM##MM}#MMMMM#kMMM}##MMMMMMMMM##MMMMM##MMMMM SECTION 2-To be tilled out by tank removal contractor: Tank Removal Contractor: JIM THORPE OIL, INC. Address: 677 E. Lockeford St. P. 0. Box 357 City: I odi f.A Zip: 95241-0357 Phone#: (209 ) 368-6175 Date Tank Removed: MMMMMMi}##M#MMM##M#MM}tMM##tkMMt#tMM##MM}}MMM###MMMtMM#kMMMM}#MMMM#MMMM#kMMMMtMM#M*#####M##M###MMMt#=>*k### SECTION 3 -To be filled out by contractor "decontaminating tank": Tank Decontamination Contractor: JIM THORPE OIL INC. Address:677 E. Lockeford St. , P. 0. Box 357 City: Lodi , CA Zip: 95 241-03 57 Phcne#: ( 209 ) 368-6175 Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved , manner as required by Cal EPA. Name: Title: Signature: Date M k91### kk}*## } MM M }kMMM}}# M#kMMtM#MM#kMMtM}###MMM#kM}#MMMM#7MMMM}tkMM##MM#MMM#M*#M#MM##MM####}#Mk TManV is free o� a'�` s'"rum e55 an c hyydrocaarbon va�lgrs �l�rtt �aPtt4t�t�cest�ira .��i�#s�ag�`aci�i el • SECTION 4-To be signed and d�ted by an adthorized represen a ive c e r to accepting tank and/or piping. Facility Name: Schnitzer Steel Products Rancho Cordova, CA Address: 12000 Folsom Blvd. City: Zip: 95742 Phone#: ( 916 ) 985-4810 Date Tank Received: Name: Title: Signature: Date EH 23 046 (Revised 08/13/99) Page 10