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ocr � :�- JY TUE 9 : Y +i sari D08sns . c • <br /> .. - A �i2 C32 <br /> OCI 15 191 08:02 ALM W.C.(415)946-99C8 <br /> NOV 12 <br /> rAN Jf5�3bUxN T.�f7f:1iT, srls?nr.•rrrx �ziYri�x-crr.=�.;;;,.� H�^,LTH <br /> •lA ERGi4OM TAM DISPOSITION TRACXINO ROOMD IAC: ;'i,•i irc r,: <br /> #YkRtkkf*tR*itt%%R#k#kkR#Rt#ik##RRXl3tXYRRRRRRR###RfCIA gCIA t#RARk*t**1***4R***f Ak k*ARX R#*tt <br /> shx;JlCYt x ^ The Sinn Joaquin Local Health Dietrictls Tracking sheet vill accoirpany each tank <br /> affixed with Its elto identiflration number, T118 Tracking Sheet is to be raturnad to son <br /> Joaquin Local Health Olatrlci within JO days of acceptance of the tank by c3lepooal or <br /> rocwliwj facility, The holEor of the csermlt with n r n tad <br /> FACILITY N <br /> , <br /> rI /t � I/ ._• ._... ♦ ..�m.N.I Y. +....1'.11W..... ...aw_.r._. <br /> a <br /> PACIL11'Y <br /> e .......__.__.. Lr ✓1l h —Ll'1 L, ..%S�S �'V (N I'l.�. <br /> TANK 20 i34;1Zw. 03 r <br /> lkR1fY%f if Rtkt!!it*ti#tk!#tRfY�11R*#ttfiRkRAt**tfiX%#%#%RtttR#i RttAAXttt*!*R#Rfittlk**#Rt* <br /> Sr mloN « 2 ^ TO be Filled out by tank removal contractor.. <br /> Tank Removal Contractor: t vV% 400 oc,-?�.S (.,t L , <br /> �+�ra>is r P p ��� � -�-� �1 i✓w'����..�..�.�,.,..r._.._,. Zi 9 r E�`y . . <br /> (� Phonsll t Yr6 �i kLz ria c.3 <br /> Tolel�hone: (•. ,,_),� Date Tank Removed 171 E� 2 7 1q91 <br /> •tRiffkilo*iXtXtit#Rt#Rtktt*tkR#!R*kA*keXRtRR*ttRRRtkttR##k!t#tk#k!!i##A*k#*i#tkki#iRtAk;1�fR <br /> sF CiCtI 3 -To be filled out by contractor "decontaminating tank"1 <br /> TO'* NCOnknfalrkition" Contractor., <br /> Mateasl L_j 104,21f. 6c.d C+470Y . .... ,-._... <br /> .:.� .. ._. c.,/ L Zips <br /> Avthozirc�l %epresenr4tivo of contractor eror ea by signing below that the tank has been <br /> "acantalRlrwtod In an s roved canner Mxegulated by Department of Health services, <br /> • N/1: W • .. -w��.I..+.Y4.r.Y.(4/:. .. ..L.Y.._....�.r+:. <br /> TI <br /> tZfi4YfiRRRR#RRRRlk*ikR*t#kk#*Yk'RYKt*DRR:tX!*%iX#kkY*k%tkk***RRItRt#*R#R#kRR#t*t*k <br /> SFA;rION 4 - To b: filled out aro signed by an authorised repzoenet4tivs n# the treatsentR <br /> xtorag(t, or dI sPOSal. fscllity-sccopCIng tank. <br /> Facility <br /> Art�reasSS �'QR2 at-� <br /> Ckite Tank Ricolvedt„�& 2.7 <br /> AVrH! RI 81(WATIkt AND TIT-L-S <br /> tkf*YfiX#tX*Atk#kfiftf*****ft*t*!Rk***###*********#Rfk#RR <br /> F.f! 2J 4f9 11/88 , <br /> > ILING INSIRUCTIONS: VMD IN HAU AND STAPi,Pu, AMIX PROP}�f pMAcE. <br /> SAN JOA¢UIN LOCAL F{ rm DISTRICT <br /> AM UNDERaOUND TANK PROGRAM <br /> P. 0. 80X 2009 <br /> OCT 15 '91 8:08 RTVYXTW. CA 9S2n2 <br /> 19166634376 PA�E . 00� <br /> 200 * 39dd DNI NOSADId3 WO'J3 S ! : 01 16 , el 1DO <br />