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TAW DISPOSITION WCINO RWORD <br /> • ft*ititttttt!!!t!!t!#R!*Rt#R#R# 1tRR!!*****tR!!#!#RlRRRRlRR!!#RRR##RRRlR#!##R#!!R##ft####tlfr#ftftft <br /> SEMON 1 - The San Joaquin 1 Health District's Ttackinq Sheet rill aCxOVMY each tank <br /> affixed with its site Identification number. The Tiracking Sheet is to be ratto <br /> Rain <br /> Joaquin Local Health Distriwithin 30 days Of �a�amptanoe of the tank by diapurne u:cned or <br /> ct <br /> recycling facility., <br /> FACILITY NAME: L-/1V l o Lp TTS . <br /> FACILITY ADWMS: l Tl LLQ t" <br /> TAMC ID 039- <br /> ftt**fttt!#tf!##t#t##!!!R##!R#*! RR!!####RRRRR!!RlRRlR####!lRRRRRR#RRRRRlRR**#RlRRR!##RR*!!!#x <br /> SECTION - 2 - To ba filled out by tar* removal Contractor: <br /> Tank Removal Contractors S S M C 0 <br /> Address: s . Ha jch Road <br /> C ILL rnia Zip:.�95351-. _ <br /> + 1:' 4- 653 <br /> Telephone: 2�- 09-r 524-9653. Date Tank Reaoyed; <br /> it#tflfttt##t#**fir*t#t#t##!lfeR#tkft>ff�Rfi#tlRt!!!]�!R!!*!t!!!tt!!R#t#lRrR*!!!*!yrllRR�ItIRIRIRf!#*!*!ll�tt�t <br /> sWTION 3 -To be filled out by contractor "devontaaIrkating tares•; <br /> Tank Decontamination" Contractor= S E M C 0 <br /> hddress: 431. 'West'Hatch Road <br /> M s <br /> Cali ornia Zi : 95351 <br /> horn : 2 4-.9653 <br /> Authorized representative .of Contractor certifies by signing below that the <br /> 9econtaminated in an approved: ewumr as be taurk has been <br /> Y =��� by �P�tsent of Hdalth Services. <br /> t ftt*#lfrftirft�t##ftftfttRt#!#!#ir#tRR�RR*##R*#RGNA*wnRAND! <br /> RTIR-1-jam#RR>t!!lRRIR**�*!#1t*#R*!R*RRt#!#*!** <br /> -wriON 4 - To be filled out acrd signed by an authorized represnetative of ; <br /> storage, or disposal facility the treatment, <br /> accepting t4rnk. <br /> �aci 1 i ty Name,_ <br /> actress: _- - _��d' � - 121—C� <br /> hone <br /> ate Tank Received: <br /> t#t#t#fr#ftlt,t#ftfeft##lRir*!#*Rt#R*R�**ZED31 <br /> RRRR�#*R�R�t*!*�*R�f�t#R#!#*##**#RR#*R#!! ! <br /> f 23 049 12/88 <br /> ULING INSTRLCrICNS: FYX.D III i11�1IF AND STAPLE. AFFIX PROPER POSU". <br /> SAKI JOM=N LOCAL NULTH DISTRICT <br /> ATIN: UNDERGROLMD TAW PROGRAM ' <br /> P: D. BOX 2009 <br /> ZGID�► CA 95202 <br /> E <br />