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SAN aOA�QL JI N LOCAL H �#T-TH DI STRICT <br /> r• - <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. Thg__bg1&g gf the Qtrmitwith qWd&r noted below re5ponsitae.Jor <br /> e t jbj� .Jorm is completCd <br /> FACILITY NAME: Sullivan & Mann Lumber Co . <br /> FACILITY ADDRESS: 16177 So . McKinley , Lathrop <br /> TANK ID 139- - <br /> �,r���*���*�*���*****��*****��*x�r*����r��r��r�**�******�,r***,rrr��r*��*��r�***�r�x�*�r*�r�r**�***��•�*�r* <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: Oil Equipment Service <br /> Adiftess: PO Box 950 Zip: 95249 <br /> San Andreas, �A .. . ._. Phoned►: 209-754- 18QZ <br /> Telephone: ( 209 } 7 54- 1808 Date Tank Removed; <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor; Nor Cal Cil Company ... <br /> Address: PO Box 645 Zip; 95316 <br /> Denair Phone#: 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 /> ��****ir**��***��*�*�****•k�c�ir*�*�ti1***�r�k�r��*rt*�*t**•k*�r�k�*�r*�r�r�****��t*�r**�k�r***�k********x�***��r <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 lnc .`of Sacramento <br /> Address: PO Box 9795 Zip: 95823 <br /> Sacramento Phone#: 916-421 - 1990 <br /> Daae Tank Received: <br /> AUTHORIZED SIGNATURE AND TITLE <br /> E11 23 049 12/89 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCCTON, CA 95202 <br />