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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br /> #ttsr#•ttataa•asaaarrtsrsasaasaasrr!!!!!!!t###ss!!!ss#f###s#s#sss#tssastss#sslsssss#sss####!#a#f####sassasa <br /> SECTION 1 - Public Health 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: Concrete Inc. EPA Site #CAC 000 983656 <br /> FACILITY ADDRESS: 749 S. Stanislaus St. Stockton, CA 95206 <br /> TANK ID #39 -.!SZ) �j�-O.f Tank Description: 5,000 Gallo Diesel Gasoline/ Waste Oil <br /> !!##!!!!!!!!#!!!!###••!t!!!!!!#tt!##t#!i!#f#!#frii!liifttft!####f#!#r##rrfat##!!###!i!!##t#i#i!##i#r•####!# <br /> SECTION 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. Beckman Rd./ P.O. Box 357 City: Lodi!, iCA Zip: 95241-0357 <br /> Phone #: (209 ) 462--4581 Date Tank Removed: 3 r y 1 2V <br /> rfart:.trf!!!t!•sse:fasrrssrs##ssrtrrrrrrrrs#srsssss#rr##srrrr#rr##rrse#r#!#rrrrr##rrrrrlrlsr*sflasasarlraa <br /> SECTION 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./ P.O. Box 357 City:_ Lodi, CA Zip: 95241-0357 <br /> Phone #: x20_9) 462-4581 <br /> Authorized 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.- � Title: !�f C P —/�e'g7j <br /> �7 <br /> #�#•1ftla!!#!!!!!r!!fl/fRrrr#!!#1r!lrfrrrrr!ltttttttrrlt••#!!##fiat#!##r!###!!#fi##!#!##!!#rrft####asirat!# <br /> SECTION 4 - To be signed and ddd��ated by an authorized representative of the treatment, storage, or disposal facility <br /> Tanis i s frees 91cce0 l s�udgegipanM hydrocarbon vapors upon delivery to Schnitzer Steel . <br /> FacilityName: Schnitzer Steel Products <br /> Address: 12000 Folsom Blvd. City;Rancho Cordova Zip: 95742 <br /> Phone #: 9( 16 ) 985-4810 <br /> Date Tank Received. <br /> U <br /> Signature: Title: <br /> ttttttttttflitt trfitrttt ttli#!#!!#!#raraata!ltrrirfrrrrfttrf tt#f!!ftlitlit!###!##i#tt;rltftarai!■#!■#### <br /> EN 23 049 (Revised 7-10-92) Page 10 <br />