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s .r J(DAQ1j 1 Zq r.. 1-imAj z°x ra x s p a car Exwer-.8 <br /> tXIM11 TANK DISPOSITrk1IV 7piL rNf; R1 1D <br /> f;�!!#R!!#y4tiRdARdtt}glpRRlR*R11RRAlAARRRAIRk$q!A!R*RNRIRRRBARlf4mR11ARRRf#Rk6RRARpARgRRId!!$$$ <br /> 5ZL 1 1 Th* San.,3oacXin Local Health Distric-t'a Tracking Sheet will ace <br /> affixed vith its 131te Identification number, return each tank <br /> dasquin Local Health District within 30 Jaya of acceptance o€ ki►Sheee leo !✓e returner! to Sari <br /> zecyclirsg Facility. by disposal or <br /> P <br /> 1 <br /> P'ACILrTY N�ii : Lodi Read Mix <br /> FACILITY ADDS: 851 E. Lod i Avenue. Lod I, CA <br /> I I'll 5 i(t.. ,= UC unii 1'.rr;f i <br /> TAPK rD 933- ., <br /> ###4R!!#RRRRRLt#NR#lRYR#RR#:S�RN�7t#* RN!##RRRAR1YftRRNNAARR R(RR�NNRAARR #RRRRARRRxtRRnRtNNRlRAR <br /> wL..... <br /> 81�G"f'ICd! - 2 - To be filled out by tank removal cantxactor: <br /> ftnk Re?aoval Contractor: JIM TfiORPE ;,n INC. <br /> esa: 3 1 P1. Beckman Road Lodi, 'A <br /> P O. 13ox 357 Lodi, C , Zip: 95240 <br /> J Phone#: !209 462-457 <br /> $1A��1t$!1$#litNa:holt$fgNgttNtRAAINR*#$x!$Rtk�FXttTank <br /> Ri�RRfe*�it�ARIA#�*�#RR�rlt$!#AARIRaiPla}t$a#x <br /> 9NgV1C 9 3 -To be filled out by contrActoZ <br /> "decontaminating rank", <br /> Tank taraination" Contractor: IP THORPE Olf., 11 , Ndr. Cal I);1 haule•• c` r !Haste <br /> Ad, su: t'C E. ac. iadi, CA <br /> --Zip. 9�c'4is <br /> Pt�onep: 6Jr? 462-4581 <br /> 1Wttwrizacml representative of contractcr cercifie_ by signing below that the tank has been <br /> Jf ds0ontaainated in an approved Banner asma <br /> y be regulated <br /> by Deparrtnt of Health Services. <br /> - -.. .� a��1Rlt$$AiRf.l:S�itkRA$l[tC*it'RRYt�t�4! AkTUR#RRXRD�gStRRAtR1tR*RRtR4N1'1tRx7tNRRttflt! <br /> f SwrICH 4: <br /> r To he filled out and signed by an authorized re ARRNRNfr#s# <br /> nttis pr disposal facility ,accepting tank' preenetativ�e.of the treatment. . <br /> ftetlity Name <br /> a - <br /> t A�dr RANCHO Cosoov.,, <br /> Phonef: _ <br /> Data .Received „��� „ <br /> A � <br /> x <br /> N � $$RRRlr$lYRRRtR#RRlRlR$RR*R!#RR##iR#$$t�#RR#NRA ! !$AUDI <br /> NA3R$f1*Rtl1kRN#$lRtRRaRxlilt Rt*ltRkta/R <br /> 013 049 12/6E <br /> I1,I190 t18'ftiUC.'!'iG3: h'QLD.t�,,HALFAMpsl'P.F[.E. <br /> 71 <br /> !4>`FIlC PR17M PWTAM. <br /> �.i <br /> SAN..JQAOUIN LOCAL <br /> H>? TH DISTRicr <br /> ATIN: LAURGROUND TAC P1tOCR1►tf . <br /> P. <br /> o. ;6 x 2009 <br /> ST00.1W A <br /> 95202 <br />