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_ SAN .70AgVIN LOC.�ar_ <br /> I'�-AL.TI-I DI StTiZ I CT <br /> UNDERGROUND TANK DISPOSITION TRACKING <br /> ###x#Y##YY###xY#Y#*xYY## **#YYxYYY#**Y*****Yxx*xxYY**xx#xxRECORD xY##xxYxxxY#Y##xYY#*x## <br /> SECTION 1 - The San Joaquinin Lo <br /> Local Health District's <br /> affixed with its site identification number, Tracking <br /> Joaquin Local Health District within 30 da�117,,,Ieptan Sheetwill accompany each tank <br /> recyclin YThe Tracking Sheet is to be returned to San <br /> g facilit ccce of the tank by disposal or <br /> m t t <br /> FACILE o <br /> TY N Sullivan & Mann Lumber Co . <br /> FACILITY ADDRESS: 16177 So . McKinley , Lathrop . <br /> TANK ID #33- Z�_- �7 <br /> SECTION <br /> *****##*x#YY*x*YY#**#*##xxxx**####xY*#*Y#x*Y##**##YY <br /> CTION - 2 - To be filled out by tank removal contractor. <br /> #YY <br /> Tank Removal Contractor: Oil Equipment Service <br /> Address: PO Box 950 <br /> n r A95249 <br /> Telephone 209 <br /> Tele o phone#: <br /> 754 209-7s� a�8 <br /> ( - 1808 Date Tank Removed; S <br /> ##xY**#####*YYY#YY*Y#YY#xx###xYxxxxxx#xxYxx*YYxxYx####xYx*x#xxxxx�a*/y� xx#xx#Y#Y- <br /> SECTION 3 -To be filled out by contractor "decontaminating tank"; <br /> Tank Decontamination" Contractor. Nor Cal oil Com an <br /> Address: PO Box 645 <br /> Denair Zip: 95316 <br /> Phone#: 800-338 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> deco tela in appy manner as may be re ulated b <br /> Y g Y Department of Health Services. <br /> SIGNATURE AND TITLE <br /> **#**##**##*#xxx#Y*x*YY**Y*Y*Yxxx*Y#Y*****xxY*#xY#**Yxx#**xx**x*#Y*Y*#*#*YYxxY*#Yx#**xx*Y** <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 /> Address: PO Box 9795 <br /> Sacramento Zip: 95823 <br /> Phone#: 916-421 - 1990 <br /> Date Tank ce; ed: U 01 �9 <br />*#YY#**#YYxYY#Y#Y*#YYxx##YYY#*#UT#0#*RY*ED##YCNxYTUREYANDxxxx�#YYYxY#xYxY##YYYY*Y*YYYYYYYY#YY <br /> Ell 23 049 12/88 <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 /> STOCKTON, CA 95202 <br />