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FACILITY NAF : Port of Stockton Foods Dist . Inc . <br /> FACILITY ADWISS; 1950 E . Miner Tkq( lot_ZZ '/— <br /> WaW TANK DISPOSITION .VWWp-`.1�. <br /> This fora is to be returned to 63n Joaquin Local Health District within 30 days of <br /> with number <br /> acceptance of tank{n) by disposal or recycling facility. The holder Of the pexalt <br /> returneed,. torted ebove is responsible for ensuring that this form is completed and <br /> To be filled out by tank reel Contractort CH 1 - <br /> Tanis Removal Contractors 0 i 1 Equipment Service �l�` <br /> Address: PO box 9S0 lone 209- 8b 111e, ,, <br /> $,fin <br /> AndreCA tip 9x010 NAV 13 1990 <br /> Date Tanks Remove /0 k p of , s'����+p�� MENTAL HEALTI <br /> ankIT/SERVICES <br /> SWTION 2 - To be filled out by Contractor "deeont,maLrating tanks)"t <br /> Tank "Decontamination" Contractor N o r C a l Oil Co . <br /> Address PO Box 645 honel 800-332-8710 <br /> Denair CAZip 95316 <br /> Authorized representative of contractor certifies by signing below that tank(a) <br /> has(have) been decontaminated in an approved Ranner as may be regulated <br /> !P�fca th Services. bySIGHATLItl AND TITLE <br /> R R ! R R R R R R R ! R R '! R R f • R R ! R # R R A f t # R f # R f # <br /> SiJMON 3 - TO be filled out and signed by an authorized representative of the <br /> treatment, storage, ur disposal facility accepting tank(s). <br /> Facility Naas Triangle Inc . of Sacramento <br /> Address 3525 - 52nd Ave k <br /> --�--•-+-- - phorlet 916-421 -1990 , <br /> Sacramento , CA Zip 95823 <br /> Cate i x o. of Tanks�� <br /> f <br /> Ail17iDRI� SIGNATItRE Atm TITLE <br /> W►ILINt2 INSTRUCTIONS: Fold in half and ataple. Affix proper postage. <br /> Eli N VC WP\TPJ=HT.E= <br /> HGV 5 05754- ?2G - <br />