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SAN JOAQL-0i COL-NL-TY PUBLIC HEALTH SERVICES <br /> EN—VIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION I- Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility The permit holder is responsible for ensuring that <br /> this form is completed and returned. <br /> FACILITY NAME: L.R. Varwig Property <br /> 16500 E. Brandt Rd. , Lodi, CA 95240 <br /> FACILITY ADDRESS: <br /> TANK ID 439- TANK SIZE: <br /> 2 ,000 pREVIOUS TANK CONTENTS: Unleaded gasoline <br /> ---------+sa{£4.£}.�#}###Y##}##}M########}##########}##i###}##i###MM}###M###i##}M##Mi}Y# <br /> SECTION 2- To be filled,out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL, INC. <br /> Address: 677 E. Lockeford St. P. 0. Box 357 City: I ndi CA Zip: 95241-0357 <br /> phone#: (L09 ) 368-6175 Date Tank Removed: —Allo oZ7,aev 2— <br /> SECTION 3-To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address: 677 E. Lockeford St. , P. 0. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone,": ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved . <br /> manner as required by Cal EPA. �,y <br /> Name:IYWRFt* �toRye Tide: ✓-P Signamrel/air Date // � DZ <br /> } }###M MMMf(� #Y }M#M###M##Ma##M#Y}M}#fiYM#MM}#MMY:##Mi####�M"#/'M`�i'M##MM#YM}}##MM##.MMY####M#.aMxaaxasaaa <br /> Tanis is free or al 's tld e5 ano hYdrocirbon vapgrs y! , c�aeLt�t�Xtest�r <br /> SECTION 4-To be signed and d ted by an authorized represen a the o e [r <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Rancho Cordova, CA <br /> Address: 12000 Folsom Blvd. City: Zip: 95742 <br /> Phone#: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Name:1"m4uk Signature Dare — c^O <br /> }#M}}##M##>M##}M###}M##M}M##M##}###>#}##M#MM}YM=MM#M#YYM}#}M>#M# i#M#}##>###}M#M##MM=M#}M###}M}M#»MaMaM> <br /> EH 23 046 (Revised 08/13/99) Page 10 <br />