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UNDERGROUND S'T'ORAGE TANK DISPOSITION TRACKING RECORD <br /> ###i11RR#1f#R4�#RRa#RR!!!♦!1•RAf#f/#v11R1/faRfa#aRa#affR#Rf#1/8111/#IRlRR########R#####!##!!##*####!!###### <br /> Sl7,-Cfii()N t - Public I lealth 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 34 days of acceptance or the tank by the disposal or <br /> recycling facility. The permit holler is responsible far ensuring that this corm is completed and returned. <br /> FACILi'l-Y NAME. Tereai Trucking <br /> FACH.n-Y ADDRESS: 900 112 E. Victor Rd Lodi CA 95240 <br /> WANK ID #39 - 707— _Tank Description. 5,000 gallon leaded gasoline <br /> ••fila#•#a#!r!!♦IR#aalr!••####•4•af#Ia11lflr!!##f!I#lt#Rala11•••#!####Ra#♦1#!##!##a!#fR###f#♦##R#####a*#### <br /> SCc'Il()N 2 - To be filled out by tank rernoval contractor: <br /> Tank Removal Contractor: JIM 'THORPE OIL INC. <br /> Address: 351 N. BECKMAN RD. / P.O. BOX 357 City: LODI, Zip: 45241-0357 - <br /> Phone ff: (209 } 368-6175 Date Tank Removed: <br /> r•♦t+•!a•••aa•raala•!•/1•#rRlalaraa♦!••!!•#1##♦tl•#R#aa!!!!###f##aR#oar!!/#RRRR#R#IIf#########f###!!####!## <br /> SECTION 3 - To be filled out by contractor "decontaminating lank": <br /> Tank Decontamination Contractor: JIM THORPE OIL INC. <br /> Address.-_P.0. BOX 357 City: LODT Zip:_ o524I_(0)153-- _ <br /> Phone #: (209 ) 368-6175 <br /> Anthotlzcd rcirresenlative of conlncctor certifying through signature below that the tank has been decontaminated In an <br /> approved manner as required by Cal EPA. <br /> Signature: Title: _ PRESIDENT <br /> • f# as #ref+f##•Raf11 RR#IrR #!!# ♦aRaRRRt#•#RI•#f##Iaa•#I#Rfa#as••••#R#R!#!R##IR##R##!#Ras###!##a#a!#!### <br /> P1p n% are free p � sludges agd I�Irgcarbo�1 vapgr u�Q �iXg dal jzer steel . <br /> StsC l' UN 4 'o a signed and date by an au torize rep serf n ve o the r at?tte , o sp <br /> accepting tank and/or piping. <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. city: Rancho Cordova Zip: 95742 <br /> Phone #: ( 916 } 985-4810 <br /> Uate Tank Received: <br /> Signature: Title: <br /> ###!!!+i!•IIf#f!t!##R###RR1!la1411!•11#�lflf#!IflR####aR#!##Ri##R!#R#f•!1a#RaR!##RR###f!#####!#####!##R# <br /> EM 23 049 (Revised 7.10-92) Page 10 <br />