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UNDERGROUND STORAGE TANK IMPOSITION TRACKING RECORD <br /> •rrrrs!••••0l0r!!!lr000s0••r0►•l04,0!!0.0!!4,►•!0.0!•sl•!r•ss►••!!0••!!••0►•!••sl00ss►ss0sss0►•►ssslsl0s•►!!• <br /> SF.Ci'MM 1 - Public Ilealth Services Tracking Sheet will accompany each tank affixed with its site Identification number. <br /> the Tracking Sheet Is to be returned to Public I lealth Services within 30 daj$ of acceptance of the tank by the disposal or <br /> recycling facility. Ilre permit holder Is reaponslble for enseiring that this form Is completed and returned. <br /> FACILITY NAME: Teresi Trucking EVA Site ' CAD 043274-180 <br /> FACILi"4,'Y ADDRESS: 900 1/2 E. Victor Rd. Lodi CA 95240 <br /> TANK 1D #39 - Tank Description: 1000 gallon Gallon Diesel Gasolitte Waste D)11 <br /> •****4,**r!•Hr•♦4,!!!••r*►!4,4,.4,4,1*f1•�1f4,4,l4,4,4,••!4,►*!r4,l�l•4,!!►•r!••!!!!••!•!!•►►►rrrr►!!••!!•►•!►!!♦!!•►H! ' <br /> S -C!lf1N 2 - To be filled out by lank removal contractor: <br /> Tank Removal Contractor: Jitn T1101-Pe Oii lttc. DBA fii.cit-tlal'L Construction <br /> Address: .351 11. Becicntan lid./ V.0. Box 35'1 City: Lodi CA Zip: 95241-0357 <br /> Phone #: (209 ) 1.62-6581 Date Tank Removed: <br /> 00***too 6640000rr►rl4,4,r4,!!!4,!►604*04,04,!!44►!•*rrrr►!!•�!!f1!!••►►►lr•r!lrrr r••►!r!!!r!r!!!•►!!!!!!► <br /> SGC;hIUN J - 'ro be filled out by a)ntractor "decontaminating lank": <br /> 'Innk Deconlaminallon Contraclor: Jbi) 'Iltot- we Oil Dl3A llicll-Mart Constr'uc Lioll <br /> Address: 351 11. Ueclanan lid./ P-0- Box 357 city: Lodi CA Zip: 952111-0357_ <br /> Phone #: ( 20_9) 1162-11581 <br /> Aulhoilmd representative of contractor certifying through signature below that the tank has been decontaminated in an <br /> approved manner as required by Cal EPA. <br /> Slgnalure: Title.- <br /> 4 6 6 6 too 0 0**too#60 0416 6 be**4*0 too#0 0 64-00#0 604#04,04,04 00#00*00 6*00006000$00#too#* $of#*0- <br /> SM <br /> itle.- <br /> *****•r*0**sr/4,0!•4,66be**!!!!•00.4,lr00#0604#04,!!0400#00*004,*00006000$00#.►0••00r0!!►rrl►0•*0000!! ♦ rof!*!- <br /> S1 f:f ION 4 - To be signed and dated by an ■uthorlaed representative of the treatment, storage, or disposal facility <br /> acre t k n IIor ipin <br /> 1,11A is free �f%`Y Mulls ge anvil hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> f'aclllly Name: ScImit7er Steel Products <br /> Addtcss: 12000 Folsom 131vc1. City:ltancl►o Cordova Zip: 95742 <br /> Phone #: 9( i6 ? 985-4810 <br /> Date Tank Received: <br /> Slgnaiute: Title: <br /> 9*r**rr4,06*r****►00l4,4,r4,r0r4100000606a 64 to <br /> EH 23 049 (Revised 7-10-92) Pape 10 <br />