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N A L-LN COL:-TY PLBLIC HEALTH SE CES <br /> SA. � Q <br /> ENVIRONNLENTAL BEALTI-1 DIVISIO`+ <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> SECTION 1- Public Health Sentices Environmental Health Division Tanis Tracking Sheet shall accompany each tank affixed with <br /> its site identification number. The Tani: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 chat <br /> this form is completed and retmmed. <br /> FACILITY NAME: C <br /> FACILITY ADDRESS: <br /> TANK ID #39 - G--�ti"�72 i TANK SIZE: I PREVIOUS TANK CONTENTS: I ' <br /> SECTION? -To be filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM TH 0 RP E OIL, INC. <br /> Address: 677 E. Lockeford St. , P. 0. Box 357 City: I ndi . CA Zip: 95241-0357 <br /> Phone m: (209 ) 368-6175 Date Tank Removed: <br /> SECTION 3 -To be tilled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM TH ORP E OIL INC. <br /> Address: 677 E. Lockeford St. , P. 0. Box 357 City: Lodi CA Zip 95241-0357 <br /> Prone#: ( 209 } 368-6175 <br /> Authorized representative of contractor certiMng through signature below that the tank has been decontaminated in an approved . <br /> manner as required by Cal EPA. <br /> Name; <br /> Title: Signature: Date <br /> Tank z s free oraT sl udge� an h��drocjrbon vag rs ygn la s t ;F�Qtt prac§jVel <br /> SECTION 4-To be signed and date by an au hortze represen a ive o e trea t, sera, <br /> accepting tank and/or piping. <br /> Facility Marne: Schnitzer Steel Products <br /> Rancho Cardona , CA <br /> Address: 12 000 Folsom Blvd. City Zio: 95742 <br /> Phone 916 ) 985-4810 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> Page 10 <br /> EH 23 046 (Revised 08/13199) <br />