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!1 <br /> UNDERGROUND STORAGE TANK DISPOSITION 'TRACKING RECORD <br /> i <br /> IR#rrr*r!#r!r#****rRr!#!!rr!!##!!#!r!r!!!•#!r!##!!!!##r!!!!#!!!!!!•4r##r#!1,l�!#!#*!!!!#!�l+1!*+#!!#++!!#*+#* <br /> 8r(;1 i(lN t Public Health Services Tracking Sheet will accompany each lank affixed l�wiih Its site identification number. <br /> The Tracking Sheet Is to be returned to Public Health Services within 30 dnn 6f 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 /> fACILN-Y NAME: 'Teresi Trucking <br /> rACII.1-1Y ADDRESS: 900 1/2 E. Victor Rd Lodi CA 95240. <br /> r <br /> TANK ID #39 - 1.7N7- Z—.-_ Tank Description: <br /> !lrrr4#l44R1lrR!#♦44lrrrR/!R4#r4RAR#rRRrl4###4##R#!!r#!!!l4RRRrr!##!!##r!!1#######!##4#R#!ff#####!#######!# <br /> Sir1'lUN Z - 'i'o he filled out by tank removal contractor: <br /> Tank Removal Contractor: JIM THORPE OIL INC. , <br /> E Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODI. _ Zip: 95241-0357 — <br /> Phone #: (209 ) 368-6175 Date Tank Removed: <br /> !!R!#141441►!4Rrrr!!#!#rr##!!#4###4#rrR##!!#####rRrR#!!!!!#r!#rrr#+ ##'#####!##!#k#!#r*##*1###i*#!#!##4'f#!### <br /> SL'(;'fl(lN 3 To he filled out by contractor "decontaminating tank": e <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address: P.O. BOX 357 _ City: LODI Zip: 45241--0'157 _ <br /> Phone #: (209 _} 368-6115 <br /> Anlhorlmd mprctctttalive Of cowncclot certifying through Signature below thatthe tank has been decontaminated In an <br /> approved manner as required by Cal EPA. <br /> Signature: y Title: PRESIDENT <br /> :a <br /> 'f# <br /> rr !! 4#fir#,+IrRr!►!! R#lrrr #### #rl1R r#lRrRr#♦t#!44#!lrRr#!!!41#Rr!####r##!#r####!i!!!##'►#!##*##A!!!### <br /> #an� � pip pin are Tree QT 1� sludgqes aC�d hy dr c rho va r u' 0 1 q zer Steel . <br /> 'U'be signed and dated by an arrtlrorized repr esenotn ve opthe �r2at iter o eg , �� sp �ai d �tyt <br /> accepting tank and/or piping. <br /> facility Name: Schnitzer Steel Products <br /> 12000 Folsom Blvd. Cit aa'hcho 'Cordova Zip: 95742 <br />� <br /> Address- Y� <br /> Phone #- (__9l 6 ) 985-4810 <br /> i <br /> Uate 'rank Received-- <br /> Signature: ;e Title: <br /> EH 23 049 (Revised 7-10-92) Page 10 <br />