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4_ P.2/2 <br /> SAN '70AQtj ~ xxC� <br /> UNDOWROMM TANK DISPOSITION TRAMING Et>7WO <br /> 88i 10N I - The San Joaquin Local. Health District'r Trac:kinq Sheet will any each �tsnk <br /> affixed with its site idmtificatlon nuatar. The Tracking Sheet is to ba returned to San <br /> Joaquin Local Health District within 30 days of acceptance of Ctw tank by disposal or <br /> xec1cling facility. <br /> $ QMlited and j etuocn0. <br /> Ave <br /> TANK XD X39--2r. <br /> SWI4N - 2 -- To be filled out by tank removal contractor: <br /> Tank Removal Contxac for: <br /> Address: jpnkA r" <br /> Telephones 20 Lon bate Tank Removed <br /> **�*x***�rir#*�t��cft*lCtM7R+kfrwt*�t#*Yt�e#tk*fk'�r* kir*skit**��t*yt*krk�+rfk�klltkk*�xatkfirMW�**�r*ir#**k**t##Ink*ic'talc*' <br /> $WrICN 3 -To be filled out by contractor "decontaminating tank" <br /> Tank Dw=ntamination" Contractor: ��- �' � �'b, p ' G- CD — <br /> Address: 22. C,�L\JA EYJ 2 At <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department ot Health Services. <br /> SICMTURE AND TITLE <br /> **,tt�t#icy#ictkir#�rtk#l�frfr*irMck**x#•t�k**r*##iki�+�Rftat*kR**rtfr#1�#*kra*k'**kk*kxrk**rk#*i��t*�fr�kxr*��r**�r��*��*�r� <br /> SECTION 4 To be flI1ed out <br /> Facility Name <br /> pass: zips <br /> Ptx�rie4 <br /> Date 'IoM Received, <br /> AUTHORIZED STGNATME AND TITd.E <br /> kt#*'X*#*�tx***R##krli'ktf*#!r1¢Jklf*irli�i�lA�C*3k#�k7klk##1t#1[�ck�k7kk*9M*tklfkfrft7llr#*�iIrYYk1k#�r1k�MItRRat1t14fik'k*ti'k*ttlr*#�c� <br /> EH 23 049 12/88 <br /> MMLING INSTRUCTIONS: FMD IN HATS` AND STAPLE. AMIX PROPER POSTAGE. <br /> SAN JOAQUIN LWAL HEALTH DISTRICT <br /> ATTN: UNDERGROCiFiO TALC PROM M <br /> P. a. WX 2009 <br /> ST=TQN, M 95202 <br />