Laserfiche WebLink
tlt�fftt tf tfftttflt/RRfRtttetttRtMt ~�^ ~� <br /> lilt <br /> IOtJ 1 The San Joaquin �..�.,.. <br /> TIxed with its site identifllcatlon In cstrlcty •• <br /> 10in Local Ileal �bw GMt Will <br /> -ycling facility District Within 30 day; of aooe ac*!ng deet is to be returned to 8each � <br /> t ptanoe of the tank by dispomal or <br /> CILITY NAM: remponsible for <br /> 'ILITY ADDRESS: <br /> Q 2,FK ID C C <br /> .asttf tf tt-trot ttltftttltttt tlttttftttttttfltttttRff!lttttttttRRttRttttttlflfttfxa <br /> TION - 2 - To be filled out b to <br /> Y nk removal contractor: <br /> Jk Removal Contractor: <br /> iress: <br /> 4 Z1p: SvZG - <br /> lephone: ( 1 �/6 Phone/; <br /> ■ fttltlttlltR/1tRt ettt: ORtltDestttt R mottttttRtttttttltfffftftfftltlttt!!tf <br /> TION 10N 3 <br /> 3 -To be filled out b �•� <br /> Y contractor "decontaminating tank*:A Decontamination" Contractor: <br /> f Cr <br /> ss: / <br /> Phone/Zip: <br /> -� a <br /> horized representative of <br /> :ontami in n a contractor �Ytb1Eel=s by signing below that the tank has been <br /> r as <br /> egulated by Department of health Services, <br /> 'TION 4 - To be <br /> Rt <br /> SIGN <br /> ME AND TI7M <br /> 'TION 1 - To be filled out <br /> cage, or disposal facility a tingWd � n authorized repees��tive of the treatment, <br /> 7ility Name o <br /> Iress: Q <br /> one/Zip. <br /> Ph <br /> e Tank Received: � -639��L <br /> .l RlftttttttttttttttatpttsettMMIZRED AM TIRE <br /> 23 019 12/8/ lftttatttattttattttattRRlRttrRttltlRRt*!tRlttt <br /> ItiG IN8IRUCTIQIg; pq� IM flkiy idp STAPLE. AFFIX Paan PASTAE. <br /> BAN ATTTT1iJ lI HEALTH DI ICP <br /> P1 0. BOX 2009"bat"M TAW I'BOGRAM <br /> CA 95202 <br />