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{ <br /> SAN J0;4 ZU7 N LOL:,41� HEiA1� rH DIE3111RIOrr <br /> UNDERUTOUND TANK DISPUSITION TRACXINC RECIDRD <br /> R**kR***xRxR**fi**XR******firt**k*RxRRRfi*R*R*RwRwR*RRR*R**RxR*RRRRR*fi*xfi*R���RRR*BRM**R*tR**RR <br /> SECTION 1 - The San Joaquin Local Health District 's Tracklnq 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 ta <br /> recycling facility, The holder of m nk by disposal or <br /> cerm' t with n�rir noted <br /> ensuring that thiLform i��omoletednnddesurned , Xe 'ble or <br /> FACILITY NAME; Nor-Cal Bever;,:c <br /> FACILITY ADDRESS: 1800 ^E^ Cr r,cr . <br /> TANK ID 039- 1104 - 'j, D�DDD 6,w( <br /> fiRx*RxxxRxxXxXxR'xx***RR*xR*fiR*RRRRRx**RR***k w h RRR*kRxfi*x'RR**xRRRx*RRRxRx***xR*RRxRR*RRx <br /> SECTION - 2 - To be filled out by tank removal contractor : <br /> Tank Removal Contractcr : <br /> Address: _ P 3; x 1 7 <br /> U P 19 4659 <br /> Phonels <br /> Telephone : ( ) h.;, : Date Tank Removed :,../ — q 916-652-5535 <br /> xfiRR*fixRRxxRRR****xRxxR**xRxRR***x*X*RRR***RRRxXRxR*xR*RRRRRRRRRR**R****RRRRR*R**R*xR*RRRxR <br /> SECTION 3 -To be filled out by contractor "decontam I nat i nq tank <br /> Tank Decontamination" Contractor ; rac`or =er. ia, <br /> Address: ..JBo xl70 rnrn- ZlP 195650 <br /> Phoneq ; <br /> Authorized representative, of contractor certifies by signing below tFuit the tank has been <br /> deconta a in nappy ed nner s may be regulated b Department of Health Services. <br /> RRRR*RxxxxRRRRRRRRRRRRRxxxR*RRx*xwXRRRRXRfiwtRxfi NDxRx*xRRRfi R*'RRRRR*fiRRRwRx*RRx**RR*RRR**RRRR <br /> SCCTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tanx . <br /> Facility Name SCHNITZER STEEL PRODUCT] C,- <br /> CA <br /> Address : RANCHO 906935.4610 <br /> _ Zipt <br /> Phonal : <br /> Date Tank Received: <br /> AUTHORIZED SIC2�ATURE AND TITLE <br /> ***R*RxRRRRRxx*RRRxR*x**RxxR*w*RRRRRRXRkxRRRRRR**fi RRRfi RxxRRRRRRR*RR*RR*RRRR***rex***R****Rx <br /> Ell 23 019 12188 <br /> MAILING INSTRUCTIONS; r'OLD 1N HALF AND STAPLC, AFFIX PROPER POSTAGE, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDO GROUND TANK PROGRAM <br /> P. 0. BOX 2005 <br /> STOCKTON, CA 95202 <br />