Laserfiche WebLink
r I, <br /> • <br /> • SAN JUA(2111N CUtll`1"l'Y I'U111,IC; HEALTH SERVICES <br /> E.NVTPONNIEKI'A1, 11EALT11 DIVISION <br /> tJNI)r,,jtG,R0tiNll S-I-()ItAGE TANK DISMSI'i'IUN TRACIONG RECORD <br /> +«««++w+++wt+ew++#+++++ww++w#+wt++##++ artY#�C11 1tittli a[Illted*** <br /> SECTION 11(111 t - 1°+rbtic health Srtvicrs Enviionmr.ntal Ilraltlr Division Tank Wracking Sleet shall eccotnptal <br /> tvir11 ir.9 life 9ilrntltieafirrn nnrnhrr. 'l lie Tank 'Fmckirtg Sheet is to be roc med tfa ilritylc 71te1PtrYttillholder Isces �t ponsibl E`r <br /> Divi^ir,n within_30-clays of acceptance of ifre tank by rhe disposal o y l3 <br /> rnsrrrinq that 11191 roan 9s completed and returned. <br /> is,d'.A. ft CAD 981682 <br /> 1 11('11,1 I Y NANIF:---_Connell Motor '!'ruck Co. , Ia Inc� _�-_�. <br /> l'ACILI I Y A11111tI'S.S:_ 2211 N. Wilson Way, Stockton, CA 95205 <br /> -- diesel fuel <br /> rA9IK 111 919 �._�---LANK sizr.,: 10,000 gal. rRrvtotlS TANK CaNWENWS: <br /> ++++A+«+++«+a«+++++«+•++++tt++w+++++w+wf++w++tw++wt#++►wt+#++++wtwr+t#w*r#*t+###t######1'**#*'�*4#*#*�**�*#*** <br /> q ,,(.•,I()" 1 - to be filled not by tank iemoval contractrrr: <br /> l:,nk Removal (:ontrac.tor: Jltu 'I'itot•M 011, Ill <br /> r- <br /> N N. t3ec ltutatr IIcI./i'.0. Box Y)' <br /> City: Lobi r CA Zip: 95241-0357 <br /> !'hour, A": ( 2U9..___)_-368-6 115 v----�---- <br /> halt Wank Reproved: <br /> ++«•+++«+«++««+++�+«a+++++.+++w++++++#ww++t##w++#+t+#+###++w+t+w#r#####t########+k*###+##t*+M##+M4M**##*#�4#1* <br /> Sr,(;'11(iN J 1,0 11e fillcrl out by corrlraclor "dCcnn1gulinnting lank": <br /> Ji.nt 'i'Irc�t• �e Oi.J.r Trrc. <br /> I nrrk Dec�ontnniinalloll '.Contactor: l <br /> Locl3. CA Zip:95241-0357 <br /> Adrb rm 35-1-N.—Beckman lid./P.O. Box 351 City: t P' <br /> Phone A: E e-0y -} —J68-6175 <br /> Anilir,ri�r,l ccr(ifying through signature below that (Ile tank has been decontaminated in an approved <br /> rrl,resr.ntativt of cnnttactar <br /> innrmcr a9 tr,rin{red by Cat UPA. <br /> Signature: Vale <br /> +«.+.+ w+*�+# .++ + +# #tt++«# + ,►+ �+++#t +t###+tw#+t##+.#�#•c�e�`fivery*.�*......+...a,.+...t+�+�+**� <br /> anrC I s rree At a rr M*Jges aril Iit roc;r3 epres vapors upon <br /> Sf( I ION 4 l o he signal and dated by an alit irot 7e representative of the treatment, stotage, of disposal laciltty <br /> accrptlriq tank and/or piping. <br /> 1'nciliry llnrnr: West:—(Nasi, 1+,(;uitnt <br /> --- <br /> Cil TurI ock �� 95381 <br /> 1lfhlress: P•C)• R)x2368 y: <br /> Phone C ( F88 )—g6(;-8265 <br /> i)nfr I auk <br /> Title: Signature: Date <br /> p1l 210,1() (Pevised 9111196) Page Ill <br /> I <br />