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.. <br />SAN 00AQLJ1N LOCAL HMAT 1TH D=STRICT <br />UNDERGROUND TANK DISPOSITION TRACKING RECORD <br />*x*******x****x*x**z*xxxz**xxxxxxxxxxxxxxx**x**********************x***xx*******x***x*xxx*x <br />SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br />affixed with its site identification number. The Tracking Sheet is to be returned to San <br />Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br />recycling facility. The holder of the permit with number noted below is responsible for <br />ensuring that this form is completed and returned. <br />FACILITY NAME: Schuler Farms <br />FACILITY ADDRESS: 9726 N. Alpine Road <br />TANK ID #39- - <br />*x***xxxzz*xxxxx***x*x**xx***xzxzz***xzxz***xx*x***x*******xzz*x*x*x*z***x**zxxxxxxz*x***** <br />SECTION - 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Don Lambert & Sons <br />Address: <br />121 "F" street P.O. Box 659 Waterford Ca <br />Zip95386 <br />: 209-874-2168 <br />Telephone: ( 209 ) 874-2168 Date Tank Removed: <br />********x*x*************xx**********z**x***x*****x**xx*******xx*****zxx*************z*zxx** <br />SECTION 3 -To be filled out by contractor "decontaminating tank": <br />Tank Decontamination" Contractor: Don Lambert & Sons <br />Address: '121 "F" Street P.O. Box 659 Waterford CA Zip: 95386 <br />Phone#: 209-874-2168 <br />Authorized representative of contractor certifies by signing below that the tank has been <br />decontaminated in an approved manner as may be regulated by Department of Health Services. <br />SIGNATURE AND TITLE <br />*x*x**x*x*xx***x****xxxx*xxx*xxxx***xxxxxxx**x*zxx*x*x**zx*xxxx**xxxxx**xxx*zx***xxx**zxxx* <br />SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br />storage, or disposal facility accepting tank. <br />Facility Name Triangel Tank <br />Address: 3525 52nd Avenue Sacramento Ca Zip: 95823 <br />Phone#: 916-421-1990 <br />Date Tank Received: <br />AUTHORIZED SIGNATURE AND TITLE <br />Ell 23 049 12/88 <br />MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />ATTN: UNDERGROUND TANK PROGRAM <br />P. 0. BOX 2009 <br />STOCKTON, CA 95202 <br />