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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> 00 to <br /> SFCIION I - Public I Iealth 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: Teresi Trucking ECA Site CAD 04 2 4 8 <br /> rACILITY ADDRESS: 900 1/2 E. Victor Rd. Lodi CA 95240 <br /> TANK ID #39 - 'U Tank Description: 1000 dors Gallon_Diesel/_Gasoline/ WasLP. Oii <br /> rlrRRRRR!l1RR111111l1111111!!lf1►1111r#1►lR11R1111111fR#l111t1118#111.111x#llsr#1♦#1fRrrfll#1fs#1#x#!11!!11 ' <br /> Sh:C I'I0N I - To be filled out by tank removal contractor, <br /> Tank Removal Contractor: diet 'IlwrPe Oil, Inc. DBA Rich-Mari Constructiort ^ <br /> Address: 351 N. Beckwan ltd./ 1'.O. Bux 357 City:__ Lodi, CA Zip: 252111-0357 <br /> Phone #: (209 ) 462-4581 Date Tank Removed: <br /> •rr•Rlxxrx/11r111s11r11xx#x#1#!11l1/too <br /> 11r1111 s1RRRxRxxxsll#1•xlxxlsx#1//11s1/slxsx11111s1ss11ss1 s111/1111x <br /> SFC PION 3 - To be filled out by contractor "decontaminating tank": <br /> 'tank Decontamination Contractor: Ji.tn_Thorpe Oil,Di1A Ilich-IlarL Construction _ <br /> Address: 351 M. Beckiiian lid./ P.O. Box 357 city:^ Lodi, CA Zip:_ 95241-0357 <br /> Phone #: ( 209) 462-4581 <br /> Awhof izcd representative of contractor certifying through signature below that the tank has been decontaminated In an <br /> approved manner as required by Cal EPA. <br /> Signature: 1.1'_IL7R JiL Title: <br /> J� <br /> rrrrr#1rx1lR1R1Rs1Rr111/1R111l11#1R#RRRl111181111sss1./1R1R1R1slx!111s11#s1lsxRx11111111Rs1s1xr1s111/1#x111 <br /> SFCI,IUN 4 - To be signed and dated by an ■uthoriied representative of the treatment, storage, or disposal facility <br /> accet k ndl!or Ipin <br /> T'14 is free t PMT s1utlge� all hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: SclmiLzer• Steel ProducLs <br /> Addtcss: 12000 Folsoin Blvd. City.-Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 ) 985-4810 <br /> Date Tank Received: <br /> Signature: Title: <br /> Rr Rrrr Rr/11R1rl x1111 x11 1111#R#1 •1111rr•rr!!x!#l1r1111#s11sR1r#1!!#11#•1!1##R#11ss11!l R1r1r11#11!!l11x <br /> EH Z3 049 (Revised r-10-9 Page 10 <br />