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SAN -JOAOL�N <br /> UNDERGROUND TANK D I SPOS I'P I OU TRACE:I NG RECORD �J <br /> rrrrttxrrtrttttttxttxxt,ttzxatstt*,r*�e***t**rxrzxtx�**xxxxtzx*xxxxtxx�r*t,�yr*�tr�r***xt*,rttrxrxzx� <br /> S�'dQh 1 - The Sar Joaquin Local Health District's Tracking Sheet 4�ail accompany each tanl: <br /> affixes oath Jt5 site identification number. The Tracking Sheet is tc be returned to Sar <br /> Joaquin Loc--a! Health District within 30 days of acceptance of the tan): by dis <br /> recycling facility. r f Pool a= <br /> r .r r pa ; t `,... r n r —� .n Fes,7 py. 4 c r ns l p �p.r <br /> ersu-it�c tiros ,.his fa*zr iY ec�mniete�-�� returnee, <br /> FA::Tr1?TM' NA►-C: STOCKTON CONTRACTING GROUP, INC. <br /> F'A CTL1_7Y ADR SS: 1000 N. Union Street Stockton, Ca. 95205 <br /> xzxxxx****xzxxrxxrrr�:xzxtxrr*tx*xrx�;x*trx*xrxzxxxrxr�rxzxxxxxxr*�;**t***rx*x**,�***,�zxxx�-xx�:*,� <br /> SIIOtr' - - To be filled dut by tank removal contractor : <br /> lari: Removal Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> Address: 1000 N. Union Strut Stkn. Ca. 95205 <br /> Zip: <br /> Phonek: 209 462-5082 <br /> Telephone: { 7 Date Tank Removed: <br /> SECTION 3 -To be filled out by contractor "decantaminating tank" : <br /> nk Decontamination" Contractor: ' Stockton Contract-in Group, Inc. <br /> dress: 1000 N. Union St. Stkn. Ca' Zip: 95205 <br /> Phonet : 2- �— <br /> utnorized representative of contractor certifies by signing below that the tank has been <br /> econtaminate,:, in an approved manner as may be regulated by Department of Health Services. <br /> SIMATURE AND TITLE <br /> K*x***xz*x'zxxtxxrr*xxrxx*rrxxxzx*trx�c�tx*zx*�rxxxxxttrzxzxr*x*xrxxzx*xrx*xx*zxxz*xxyr**xxxr�x�r <br />' =lg - <br /> To be filled out aria signed by ars authorized represnetative of the treatment, <br /> atora e or disposal facility acceptina tank. <br /> a:�alitl <br /> Name Stockton Contracting Group, Inc. <br /> dress : 1000 N. Union St. Stkn. Ca. <br /> Zi . 95205 <br /> Phone t : (p209�p�r <br /> ate Tan). RecE:ved : <br /> xxxxxxxxrzxxrx*,r*x*x�rttx�rxx*x*zLFZxR,rxZEE�txx*SIGNATURE <br /> xrrAND <br /> *zxx xx*xxzxtxxzxx***�c,rx****xxxx*�t*r* <br /> F 23 049 1218E <br /> T:.ING IN.7IRU':"I I CNS: Itr HF,LF AND STAPLE. AF?IX P'RCPEP POSTAGE. <br /> SAN JOADUIN LOCAL HEALTH DISTRICT <br /> AT N: UNDERGROUND TANK PRCMAY <br /> P. 0. BOX 2009 <br /> 'TON, CA 95202 <br />