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E <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> !###R!f##!###!!#!!!!###!#####f#4ffRR#R!!fRlRR###!#!##!#!##!#!#!!####R!!1!##f#f4#4#R#!####!#444######!#l444! <br /> SWVION 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 duya of acceptance of the tank by the disposal or <br /> recycling facility. The permit holder Is responsibie for ensuring that this'form;is completed and returned. <br /> E <br /> FACILITY NAME: Teresi Trucking <br /> E , <br /> w <br /> FACILITY ADDRESS: 900 1/2 E. Victor Rd Lodi CA 95240 <br /> E <br /> TANK ID #39 - Tank Description: 12,000 gallon diesel <br /> Sr,CTION 2 - To he filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM UORPE OIL INC. <br /> Address: 351 N. BECKMAN RD. / P.O. BOX 357 City:_ LODI, Zip: 95241-0357 <br /> Phone #: (209 } 368-6175 Date Tank Removed: <br /> - <br /> SECTION 3 - To he filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address: P.O. BOX 357 _ ._ City: LODI Zip: 95241-01157 <br /> Phone #: {209 368-6175 <br /> Ih <br /> Awhorfzcd rcinesentative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA. <br /> �o- <br /> Signature- 4 Title: - PR S <br /> !R !a <br /> dank p1p n� are free f 11 b sludges agd hgdrocgrbor vap r� u�v �a Ji8pgspto-,S rAi jj zer Steel . <br /> E SI;C ION 4 - �o a signed and ate by an au torize rep sentr4 ve o the rat a or , <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City: Rancho Cordova Zip: 95742 <br /> E ;F <br /> Phone #: 9( 16 ) 985-4810 i <br /> Date Tank Received: <br /> Signature: 1j Title: <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />