Laserfiche WebLink
i <br /> %./ <br /> UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> •!Hflftf###t NtalffafN!l Rif N iiRR!!RR!lsRnRlnnRtliRSRRlRli!!!fR#t#R!#fa!lRfR!!!#!f!!!!!##!###!!!#!!!!!!## <br /> SECTION 1 - Public Health Services Tracking Sheet will accompany each tank aff xed with Its site Identification number. <br /> The Tracking Sheet Is to be returned to Public Health Services within 30 doss of acceptance of the tank by the disposal or <br /> recycling facility. The permit holder is responsible for ensvrirtg that this form is completed and returned. <br /> FACILITY NAME: Concrete Inc. EPA Site #CAC 000 983656 <br /> FACILITY ADDRESS: 749 S. Stanislaus St. Stockton, CA 95206 <br /> TANK ID #39 -Sa SI -0 Tank Description: 5 1000 Gallor Diesel Gasoline Waste Oil <br /> r!!f!!!!#flftt!litrttR!!!!##tirtii!!lRitr!!!s!!!!!!f!!!!falffl!!alt/##fftfnf•!!Ri•!!!!!!!!!f###!#!!#!!!#!R! ' <br /> SCCTION Z - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Jim Thorpe Oil Inc. DBA Rich-Mart Construction <br /> Address: 351 N. Beciunan Rd./ 11.0. Box 357 _ __ _ _ City: Lodi CA Zip: 95241-0357 _ <br /> Phone #: (209 ) 1+62-4581 Date Tank Removed: <br /> r•if lflr!!rtlflt!•lrrR!!!•!!i!!N atlraatfa#!##!!!•!!!!l11f!laata!###!#!#il Rnn!!Rf!#!aR#!N riff!##!!R!!!!at! <br /> SW ION 3 - To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination Contractor: Jim Thorpe Oil DBA Rich--Mart Construction <br /> Address: 351 N. Beckman Rd./ F.O. Box 357 City: Lodi, CA _Zip: 25241-0357 <br /> Phone #: ( 0 462-4581 <br /> Authorized representative of contractor certirying through signature below that the tank has been decontaminated In an <br /> approved manner as required by Cal EPA <br /> Signature: Title: /.0 e <br /> frrrr►!!!leeafffassir!!!rilr!latali•IIsi!!—JR!!llaiaa!!t!!!r!!lial <br /> SECTION 4 - To be signed and dated by an muthorized representative of the treatment,storage, or disposal faciilty <br /> Tank is freee�tga� s udgeVpa% hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> Facility Name: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City.Rancho Cordova Zip: 95742 <br /> Phone #: 9( 9 985-4810 <br /> Date Tank Received: <br /> I <br /> Signature: Title: <br /> rfrfrlsftrirlrrr!!lsasattaa#rrarlssffsaatttt!!!!!lsafoar#satttlilssa!#tsa#!!ss•#!!nlsffrssiaa#!ra!lafff# <br /> E4 23 049 (Revised 7-10-92) Page 10 <br />