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I V J1.-,lk , I JJ-;,Cll. AL I A V1ul\.Y IVl:V <br /> SANIUAQUINCOUNIT <br /> )MI MANNA 1,11).,MA.11. <br /> IluhhUllire c�tip )d11�* <br /> P.U. iklx Am? • (16f11 Bast lismilts"Arrnue) of Sfukltnl.(;allfornlx 95201 <br /> (2r19) 4(m.34ou <br /> UMMIt0ltOtINO 'IANK I)ISI'031110N TRACKING IMURD <br /> r•n•ntr••rrr••••r•r•r••r••••••••r•••••••••••••u••r•••r••••••••,••••••••••••••••••••••r•••r•••r••••r•r•r• <br /> Stir:l loft I I - 1,111111C I Icnhh Sclvices 'I rncklnP Sheol will accimgm oly each tank affixed with IIs site Identification numbet. 7116 <br /> ilnrking Shce1 1.1111 he rrtnntrd to Public 11en1111 Scfvlcr.c poll 11111.30 dgtj of acceptance of the Innk by the(1131105"1 of Ie9cII"9 <br /> IncllUy. "lite permit holder 13 rca110m31ble 101 cnsnring That 1111.1 furan Is completed and returned. <br /> rACILII'V NAME: Valley Wholesale Drug Co Inc C )9(t * 001022416 <br /> UACILI IV ADDRESS: 1401 W. Fremont St. Stockton, CA 95203 <br /> IA11K Ib AJ9 • Tank bcsul11tlon: 11 ,0000 gallon gasoline Tank d Goy" /1?7 <br /> of 1••••••••••:.•••n rr•••••••••r••.•toff goof off, r••••• <br /> sla'IIfIII 1, - '1'0 he filled 11111 by tank removal contrnclur: <br /> fail It Ite"Imal Contractor: JIM 1110101 UIL, INC. UUA 111CII-MAR► CONSTR. <br /> Arblim : 351 N. Beckman Rd. , P. 0. BOX 351 City: Lodi <br /> r,pCA ` L Zip: 95241-0351 <br /> rhm,e d: ( 209 ) 368-6115 Date Tank ILanoved: <br /> •r•t•ttr••rrr••••••n rr•rr•••.r•rr••••r••••••••rr•r•••••••••••r••r••r••••••••r rr•rrrrrrrr•r Hrrur�rrrr�rr• 1 <br /> SYr'I RY14 .1 - k1 he filled out by cmltrncto/ "decontnodnndn6 tank': <br /> 'Innk Dcconlnminntlon cnnhact6r: JIM 1110I1PE OIL, INC. UUA RICII-14ART CONSTR./Nor-Cal Oil <br /> au er o r "sate <br /> Addtrss: 351 N. Beckman Rd. 1 1'. U. Uox 351 City: Lodi , CA Zip: 95241-0351 <br /> rhnnc N: ( 209 ) 368-6115 <br /> Anffimixrd repreaentative of alntractrn certified by 3lgnhrg bel11w that the Innk has been dccunlnmlnaled In on approver) <br /> manner as requited by the Slate Depnrtrnent of Ileailh Services. <br /> Slbnnhnc: � <br /> 'I life: <br /> ..r• n r. Off$ •. .•• . r•.•rr•• r••1.••r• ••r•.r•.rir••.••••• • .••r•• r•• r •..•r••.•.••• •••••••• <br /> lank is IFea or art sf11 ges ant(llyrlror.arr�on va`tors upon crgrrvery eo Stcfuli�zer tr , <br /> S11C1lof f 4 . '1'0 he signed mar dated by nn nutflurlred represel Inure v the Ireatmcno, stvra6c, or d limal acl{1 1 <br /> accrplhl`tank andA)r I I I <br /> i'"cilliq <br /> Addimi: a o d cloy: IP: SL o <br /> Dnlc lm,k Itecelve 2- <br /> Slgnahne: _ Ifile! l C Ltd <br /> •............................. ..•...•.6••..t.••..... ...... •.•••.••.•.•••••••••••• <br /> rage III <br /> to 77 1146 tato 2/n/vr1 vp I <br /> A mldrinn of$•n)nrman Cmm,/Ituhh f.•rt knlaa <br /> \� <br />