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03'19/2005 14:02 5102353709 ECI RIC440PID PAGE 02/05 <br /> 03/19/2009 :2:51 9163731173 WALTOM1IEK NEOXNG PAC$ 02/02 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telarphoolet(2o9)40,Uzo Fu:(209)4W433 <br /> U MI1111 i1SMRAG6Taif DISMSITIONTAACIM0RlGCORD <br /> N N•Hf pNlN1Ntl•}IMMu•pttll•Kt11NY1H.Nq MNN{wHN!a•MNntNNNytpal yflNaMOf 1•I.4 M• <br /> 96Cf'fON 1 - S.'C Swht Iamw mmidt Department's Took Tmokbtg Sboet shill aeompany 41146 funk tlti%ell Vold'im"mIdentlEcciOa mrmber. The Tank Tmckio6 Shmt is to hf atumcd to the %virmimmw Health Depaimcm w1fMa 1d d11vs of <br /> m sa mmae of 1he tank by the disposal Or racy044 fi:Jity. The pamit holder Is regwrtalble 'br ea miq that this form is <br /> o0mpiaeea Andtatnmed. <br /> FAC1U7V'4Aid1'i: Joa's Tzav 1 Pl za - <br /> PACL'.ttY.A0DR9SSt 15600 Sc, <br /> _it' Harvard Road. Lathroo, CA 9533C <br /> TANK SD d39- TANK SIZE: MUrMUS TANK CONTENTS: Petrole <br /> •rR••wMKG4•.•H•.•..YMTFI4H4N••Nf NH.u4MNKfuHK.NN•Nor4NN aN•N•.NH..H.N4.•a.••a I. <br /> 58cTTOh4 2•Tobe filledatn by tank remeYei 60117eltor. <br /> Tank Ratrovm CNIZeQec Wai tea tin <br /> Address: PO Ht7X 1025 City: W®at Car ZIP: 9nrLom <br /> Fbftd,f 9161 313-1152 Does TankRamoved• <br /> N•H1Na1YN•.M•NMIYH tN•MiN.•••H•N•KI.N•.••NIN4NHQ4NIn•1.•.KT4N NNHuga4N••H41.•a• <br /> SCCTION S•TObc fdkd Darby aptvaclnr"tlatoatamtnetlnQ bak": <br /> Tacdt rA0 ttMlnsdar Commxar: " f���•7I�'• _,,�--� , <br /> Addr!W roe tlty.li QS�S�/ <br /> Pham M: <br /> Amha:iLed tepfEsdnedre tdmuuactor mK*blg terobgh slgnmvasalew thK ttu tactic hu bat dew zmi mrd to an epptovm <br /> ntanxr mrtquked b}CelP3A. <br /> � rariBf <br /> Name: 32fre0�,/1 J�reX Title: fig B <br /> ItIV•NVANN4H•Ht•HIHIO H•4H•NINHsaft.Npga1'1N.N NIN•NM un HN gNY•u.MpN.•..N. <br /> SWrPN 4.To.be signed and da0.d by an Outberlud Polar Wall"0f the n4aunem stomile,a dlepMl faclUtY <br /> accepting tabic mdlor piplag. <br /> Facil^.}Nema: <br /> Cl <br /> Addrur. r✓ City! '� r/�7.ip; 94� / <br /> phoned•=S� <br /> Darr 70k;Received:_ 4/ 57 <br /> Name: 1-..IP�Il) 1 eX Trtic� gdeoae: a a2G-D <br /> N4.a44atNNNfN.•N•tLlN4N•Hsa.11•w.......... .•.....•. •w••...M......•....N..... <br /> EH 23'N6 lRovisad 071iU081 10 <br />