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SAN JCA C.JI rI LQCAL., H '.A.LTH l�2 S'I'RI CT <br /> i - <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> affixed with its site identification number. The Tracking Sheet is to be returned to San <br /> Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. <br /> !2f the emuLing t Crijit w t - <br /> m t <br /> FACILITY NAME; Sullivan & Mann Lumber Co . <br /> FACILITY ADDRESS: 16177 So . McKinley , Lathrop <br /> TAMC ID 139- <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: 0 i l Equipment Service <br /> Address: PO Box 950 <br /> Zip: 95249 <br /> A Phone#: 9-7 • - <br /> Te le,phone: ( 209 ) 754- 1808 Date Tank Removed: <br /> SDCTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: Nor Cal 0 i l Com a n <br /> Address: PO Box 645 <br /> Denair Zip: 95316 <br /> -hone#: 800-332-8710 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> SIGNATURE AND TITLE <br /> SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name Triangle Inc .--of Sacramento <br /> J <br /> Address: PO Box 9795 <br /> Sacramento Zip: 95823 <br /> Phone#: 916--421 - 1990 <br /> Date Tank Received: <br /> AUTHORIZED <br /> GN**TU[�2E*At��IDTITLE <br /> �**�*xrr*�r*�**�**�*�*�r*�r�t�t:r*�r�r <br /> Ell 23 049 12/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AT'FIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDMGROUND TANK PROM M <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />