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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />••••.••r••••rrr•cru••r••♦rrr•♦rr•♦rrr•,••rurr••••r••rr,rr••rr•rrr•rrr•rrrrrrr••r•rr•�•r•r•rt•rrr••ri•••r• <br />SECTION t - 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 days 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 #CAC 001001248 <br />FACILITY ADDRESS: 7500 W Linne Road Tracy CA 95376 <br />TANK ID #39 - w Tank Description: 500 Gallon Diesel/ Gasoline/ Waste Oil <br />....•.........r,•.......•.........•.....•.•...•........•..................•.•••rr•rrrr•r•rrr•••rrrrr r•rrrr• <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jini Thorpe Oil Inc DBA Rich -Mart Construction <br />Address: 351 N. Beckman Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone #:L0`( 9 ) 462-4581 Date Tank Removed: <br />•••••••••••••••••••••ur••r•rr••,•r••••••••r•r•urr•r••r••••••r♦•r••••rr••••••rrr rrrr••rrur•rr••grr••r••• <br />SECTION 3 - To be filled out by contractor 'decontaminating tank": <br />Tank Decontamination Contractor: Jim Thorpe oil,DBA Rich -Mart Construction <br />Address: 351 N. Beclanan Rd./ P.O. Box 357 City: Lodi, CA Zip: 95241-0357 <br />Phone #:( 20 462-4581 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as requited by Cal EPA. <br />Signature: <br />•••••, r•••rurrrrr•••rrrr•.•r•••...•rrr••••r•ru•r••,rr•r•••rr••rrr••••rrrrr•»•rrrr•rr•r•••,•urrr•rrrr•rr <br />SF.CIION 4 - To be isiigned and dd/ated by an authorized representative of the treatment, storage, or disposal facility <br />Tank is free gaj s�udoRipenrA hydrocarbon vapors upon delivery to Schnitzer Steel. <br />Facility Name: Schnitzer Steel Products <br />AdrlrPss. 12000 Folsoin Blvd. Chy:Rancho Cordova Zip: 95742 <br />Phone #:( 916 ) 985-4810 <br />Date Tank <br />Title: <br />ER 23 049 (Revised 7-10-92) Page 10 <br />