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SAN JOAQL-L-4 COL-i TY PUBLIC HEALTH SERVICES <br /> ENVIRONNfEN TAL HEALTH DIVISION <br /> LN-DERGROL-N-D STORAGE TANK DISPOSITION TRACIM G RECORD <br /> SECTION 1 - Public Health Services Environmental Health Division Tank Tracking Sheet shall accompany each tank affited with <br /> its site identification number. The Tank Tracking Sheet is to be returned to Public Health Services Environmental Health Division <br /> within 30 days of acceptance of the tank by the disposal or recycling facility. The permit holder is responsible for ensuring that <br /> this form is comoleted and returned. <br /> FACILITY NAME: S . T. Services <br /> FACILITY ADDRESS: 3505 Navy Dr. , Stockton , CA 95206 <br /> TANX 4#39- qq- S TANK SIZE. 500 PREVIOL"S TA--NX CONTENTS: Gasoline <br /> #y[�t�t�t�t�tytAt t*�nM�t�t#*Init*Init�t K**�*�t#�t�fM�**It�t�nit�t****��•}.,..,..R.rtm.•.f=___ .��,- rrr:r)it Jnitat=]Inst=]I[=It�nit It It It*�nit�nit Init Init�nit�l�niti.*7.sit�'R"-- <br /> SECTION 2 -To be filled,out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil , Inc . <br /> Address: P.O. Box 357 City: Lodi , CA Zip: 95241-0357 <br /> Phone 4: ( 2 0 9 ) 368-6175 Date Tank Removed: <br /> SECTION 3-To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil , Inc. <br /> Address: P.O. Box 357 City: Lodi , CA Z; : 95241-0357 <br /> Phone#: ( 209 ) 368-6175 <br /> Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an approved <br /> manner as required by Cal EPA. <br /> Name:Martin Thorpe Title:Contraetor Signature: Date <br /> dank is, Tree of. a l sdt�dr�dsb and h droc rbon v dors ��o� deliver to Sc�bnit�%f . tee/ <br /> SECTION 4- o be signed an y an aut orize represen ative of a eatment, st ra,e, or spos ac iry <br /> accepting tank and/or piping. <br /> Schnitzer Steel Products <br /> Facility Name: <br /> Address: 12000 Eolsom Blvd. , Rancho CordovaCiry: CA Zip: 95742 <br /> Phone#: ( 916 ) 985-4810 <br /> Date Tank Received: <br /> Name: Title: Signature: Date <br /> EH 23 046 (Revised 08/13/99) Page 10 <br />