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SAN JOA,-VIN LOCAr. HEAr�T1 DI S'ITZI CT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> xxx*xx*****x******xx*x******xx******x*x*********xx*x**x***x*xxx*xxx************************ <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: C74.4ksAA Z_ 1-fA <br /> Q J <br /> FACILITY ADDRESS: ,/�hD 8 Nnu St2 14-1, 1 A'le-k � aw-011ceA ?A- <br /> TAW ID 039- <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor:— 15W nNe2 <br /> Address: Zip: <br /> Phone#: <br /> Telephone: ( ) Date Tank Removed: <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contarctor: ¢p f ro. -� 1-il-_ y/a'��/ <br /> 3 ^f� o2P� D, � <br /> Address: 90 Z 64,gc4 Uw)-/wo-D 4-01, I Zip: gS�Y0 <br /> Phone#: _ / <br /> Authorized representative of contractor certifies by s: going be ovv tthe tank has bee <br /> decontaminated in anappr`�/%' mmay be regulated by Department of Health Services. <br /> SI ATIND TITLE <br /> SECTION 9 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> SCHNITZER STEEL PRODUCTS W. <br /> Facility Name 12000 FOLSOM BLVD. <br /> 1 v <br /> 916-985-4010 <br /> Address: Zip: <br /> Phone#: <br /> Date Tank Received: <br /> A PIZE2) SIGNATURE TITLE <br /> EH 23 049 12188 <br /> NAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. O. BOX 2009 <br /> STOCKTON, CA 95202 <br />