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SAN '7C)A(2XjIN LOCAL, Il ar.TH D2STRICT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> z**x******x***x**z******zz**z****z*****xz*z**z*********xx***z*zz**x*zz***xxx****zzxz******x <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will a <br /> affixed with Its site identification number. The TrackingSheet is to <br /> Joaquin Local Health District within JO days of acceptance of the tank b accompany each tank <br /> recycling facilit be returned to San <br /> ensuring that this for The holder a the oc�rml with nu b y disposal or <br /> ompleted arvt to n ,� not d 1 w is responsible <br /> 0 <br /> FACILITY NAME: Delta National Bank <br /> FACILITY AD <br /> DRESS: 611 North Main Manteca, Ca . . <br /> TANK ID 139- Z <br /> SECTION :. `v:vlt(j�ra� f1 <br /> - 2 - To be AL <br /> filled out by tank removal contractor: III <br /> f �jx ***x* <br /> Tank Removal Contractor: Don Lambert & Sons <br /> Address: 121 F Street/ P. o . Box 659 Waterford , Ca . <br /> Zip: 95386 <br /> Telephone: 209 Phoneq: <br /> 874-2168- <br /> Removed: <br /> S 209_58 <br /> ***x*x*xz**z+(** ****** z****x*x*x*x*x***z***xzx*******xx*xx*x***xz*x*xxxxx******x*xx**xxx** <br /> Date Tank Removed <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: Same <br /> Address: <br /> Authorized representative of contractor cerPhonel: <br /> decontaminated in an approved manner as tifies b Y signing below that the tank has been <br /> may be regulated by Department of Health Services. <br /> *x**z*xxxzzxxxx*z**x*xxz**zx***xxz*x*x*z*x *xxxxD TITLE <br /> *xzzx***xzzzxxx*****zzzxzx*z***xzxz* <br /> SECTION 9 - To be ,filled signed by an authorized represnetative of the treatment, <br /> storage, or disposal faciout and lity accepting tank. <br /> Facility Name Cal Coast Manufacturing <br /> Address: 424 S. Tegner Rd . Turlock, Ca . <br /> Zip: 95381 <br /> Date Tank Receiveds Phoneq: (2pg )_ 6 <br /> ***x****x*1218***********Fk***z*Xzxx**D*zx***z******z**xz*zz*******zz**zz***zx*z*z****zz*x <br /> SIGNATURE 111111,11,11,11)"T <br /> Elf IJ 049 12/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN UNDEnGROUND TANK PROG2AM <br /> P• 0• BOX 2009 <br /> STOCICTON, CA 95202 <br />