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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />•rr•r•r•••rr•••rr••••••rr••••r•r•r•••••r••••r••••rr••r••••r••r•♦r•rr••u•r••••••••••••�•••••N•••u•••••••• <br />SECTION I - Public Health Services Tracking Sheet will accompany each tank 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 tank by the disposal or <br />recycling facility. The permit holder is responsible for ensuring that this form is completed and returned. <br />FACILITY NAME: Jefferson School District EPA Site 2CAC 09 190 1 248 <br />FACILITY ADDRESS: 7500 W. Linne Rd. Tracy CA 95376 <br />TANK ID #39 - 1 Tank Description: 500 Gallon Diesel/ Gasoline/ Waste Oil <br />...........r••r••r••••rrr••♦r•••r••••r•r••••••rr•••••u:rrur••••rrr••r••••rix••••••••••...•••••.•••••••••. <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jim Thorpe Oil I Inc DBA Rich -Mart Construction _ <br />Address: .351 N. Beckman Rd./ P.O. Box 357 City.. Lodi, CA Zip: 95241-0357 <br />Phone #:(209 ) 462-4581 Date Tank Removed: <br />•.••ix•••ixrixixixixrrixrrrix•ur•ixr•ixix•ix•u••♦•ix•uixixix••••••ix •••••ixixix•••ix••rix ••ixix•ix••••r• <br />SECTION 3 - To be filled out by contractor "decontaminating tank': <br />Tank Decontamination Contractor: Jim 'Thorpe Gil,DBA Rich -Mart Construction <br />Address: 351 N. Beckulan lid./ P.O. Box 35'7 City: Lodi, CA Zip: 95241-0357 <br />Phone #:( 2091 462-4581 <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 />...............r.•...rr•r•ur•rr•••r•u•••ix•••ixix•r•ix••••ixrr•ixrix••ix••. •..••••.•••.••..•.•••••••••..• <br />SECTION 4 - To be �siigned and dd/ated by an authorized representative of the treatment, storage, or disposal facility <br />Tank is free �itf % j� s�udgegipaA hydrocarbon vapors upon delivery to Schnitzer Steel. <br />Facility Name: Schnitzer Steel Products <br />Address: <br />12000 Folsom Blvd. City. Rancho Cordova Zip: 95742 <br />Phone #: ( 91 6) 985-4810 <br />Date Tank <br />Signature: <br />ER 23 049 (Revised 7-)0-92) Page 10 <br />Title: <br />