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SAN JOAQ' 72N LOQ,` F�-A2.TF-* D2 STF22 C`T — <br /> UNDERCROMD TANK DISPCSITICt4 TRArKING RSD ' <br /> �YttktYiiYtYxtxtx t:tYYYYxtYktY;;rX%YxtY;YxxYY%fi xxxYxix;xk;YkYxxtYxtYxix*xY;lttrxxY* / <br /> d '- - The San Joaquin Local Health Distric 's Tracking Sheet vi 11 accompany each tank <br /> ,xed with its site identification n <br /> -aguin Local umber. The Tracking Sheet is to be returned to San <br /> Health Dist is within 3U days of acceptance < <br /> recycling facility. Zhe hold Ptance o< the tank by disposal or <br /> =tsar+ra that his for � <br /> 1 comolet. and etl, „„a °W ' s ib e for <br /> FACILITY NAME: GUARDINO & CRAtJFORD Co. <br /> FACII,I;"Y ADDRESS: 317 [�. Fremont Street ` "is `,:a• <br /> 0 <br /> TANK ID #39-� <br /> x x;Sx;YxzSXtixxYYtYY%Y2kYY2kY2 YYY;XYxx2ix:xxiYxxxxxxxxYkxx%xxxxzxxxENr IRO NM ENTAL HEALJT <br /> SFS ICN - 2x� ►.. �l; yfjlxr�xxxkxk <br /> - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Stockton Contracting Group, Inc. <br /> Address: 1000 N. Union Street Stkn. Ca. <br /> Zip:. 95205 <br /> . Phone#: (209) 462-5082 <br /> Telephone: � 209 � 462-5082 <br /> xtixxtxxr*xtrtxrxzxxYxxtxszrxzYxxtixxxYrrzr--rYYYx Tank tRemoved: <br /> xxx--------xtxxxrxxxxxxxrx:YYxxx <br /> SECTION 3 -To be filled out by contractor "deconEaminating tank" : <br /> Tank Decontamination" Contractor: Stockton Contracting Group <br /> Address: 1000 N. Union Street Stkn: Ca. <br /> Zip: 95205 <br /> Phone#: (209 462-5082 <br /> Authorized representative of contractor certifies by signing below that the <br /> decontamina an a owed manner tank has been <br /> may be regulated,�p�tment of Health Services. <br /> xixzsxxxxxxtxYx:xxxxx xxtxxrxrrrzxixlYYxxTxxxrttt� .ITLE xzxitxxxtxxxxtxxrxzxxxxkXYikrxxxx <br /> SECTION 4 - To be fil ed out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. . <br /> Facility Name ;�j k&Tja.-L cu . ZJVC . <br /> Address: Zip: 9�76� <br /> yTA-f�f0 ! Phone#: Fglf34RF' 800a <br /> ^ate Tank Received: <br /> x%zkxxxxxzxrxxzxxxxxxz:Xxxxzxz xr`xxxORI ZEr) SIGNATURE AND <br /> xXXLxzxzxxxzxxxxxxzxxzzxzxzxxxzxxx;: <br /> 23 049 12/88 <br /> XA:LING INSTRUCTIONS: FOLD :N HALF AND STAPTE. AFFIX PROPER pcS-AGE. <br /> SAN JOAQUIN LOG1L HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. O. BOX 2009 <br /> ST'OCKTON, CA 95202 <br />