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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> ••....•..•.••.•.•.••..•....••...••.•...•••••••••.•.••..•.••..••.•••..•.•••.•.•..••.•.•••••••NH••1•••••.•. <br /> SECTION 1 - Public Ilealth Services Tracking Sheet will accompany each lank affixed with its site Identification number. <br /> The Tracking Sheet Is to be returned to Public health Services within 30 dans of acceptance of the lank by the disposal or <br /> recycling facility. The permit holder Is responsible for ensuring that this form Is completed and returned. <br /> FACILITY NAME: Ramsey Real Fstate Dov Fi l hert P ty EPA Site VAC 001004008 <br /> FACILITY ADDRESS: 740 N. Filbert St. Stockton, CA 95336 <br /> TANK ID #I9 -�5 I� Tank Description: 550 Callon Diesel/ Gasoline Waste Oil <br /> Sr(:[ION 1 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim 'Thorpe Oil Inc DDA Rich-Hart Consi,ruction <br /> Address: 351 N. Beckman Rd./ P.O. Dox 357 City: Lodi, CA/ �pZip: 95241-0357 <br /> Phone #: (209 ) 462-4581 Dale Tank Removed: 91 0 r <br /> SF.CIION t - To be filled out by contractor "decontaminating lank": <br /> 'Tank Decontamination Contractor: Jim Thorpe Oil,DBA Hich-Hart Construction <br /> Address: 351 N. Beckman Bd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br /> Phone #: ( 20y1 %2-4581 <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: �MA A A Thle: V <br /> 7 <br /> SECTION 4 - To be signed and dated by an authorized representative of the treatment, storage, or disposal facility <br /> ecce t k nd/or Ipin <br /> lank is free �i�Aa�� s�urgeg anti hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: <br /> Address: g2 City: Cil- Zip: z o <br /> Phone #: 2� _ � �e O <br /> Date Tank ReceNcd In <br /> Signature: �'7 Title: <br /> EN 23 049 (Revised 1-10-92) Page 10 <br />