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-SAN, 702W <br /> ` w LVMG "D TANK DISPOSITION TRA�rNG'RECCRD FEB 2 <br /> it*#ittt��F�i lk�G�C�t �k #its��t###xttststtirtt*txxst*�tie�e**�rittrriNiwxwx "r�xxNr►rr�r�r�xx�4+ iVP R 1'4t 11 44 <br /> SK7p1w = - The San iloagain Local, Health Disrrict's Trar+ing T­Beet gill accompany each tank <br /> ±xed with its site id,ntification number. The Tr,' iseet is to be returned to San <br /> Local Health District within 30 days of acceptu �:�e a the tank 'by disposal or <br /> -- -�ing facility.. holder g the carmit „D " <br /> �. <br /> ,rrt <br /> . w� <br /> Ided and <br /> 4 l} <br /> �'AC;L Elf :��l <br /> ,AGILITY ADWMS: j ILL <br /> i;v1K ID 039- <br /> :�7C#SIC#7k#�t*'##1�YitlClk#*it#9k#iclt#SI'�Y�k7IM1k;�fkltit�*7k***7k 7k�ClCit**iC1t#*�t*lk7tlC'ft�t#�it]t![�fcsYslt*1r*ltft***flitlklC�kitA'lklMlRi1'1kiY'***1k <br /> ,t <br /> SECi'I'ION - 2 - To be- filled out by tank removal contractor; <br /> Tar.'- Removal Contractor: � <br /> Address; ���..- -- �K 'I` � �� �. Zip. <br /> 0 . <br /> a <br /> Date Tarn Removed <br /> 1 i <br /> Address: D Zip. _ <br /> _. ..,..-- Phone#* <br /> Authorized representative ai con€ractor certifies by sLg%ingo�'I,be104 thfit�the tank has been <br /> decant s:±abed ari approved,mea 4iee kis may be .regulated by.Depax ent of Health. Services'. <br /> SIGNATURE AND TITLED <br /> �rfkit;fr*rti4*xtieiefrirxSt7k$�EiF#c*iC�;irt**��kfr7ti�$�k7t1C'*1r7k7rx1kyS?C7tiClki�xlrx7cacx7C7tirlt**�litit7ti�,tyC�r7r� t*ir7t*x*iClC1k'k�k*7l`*###* <br /> SEf TION 4 - TO be f il1ed. out drid signed ley an authorized represnei Live- of ,the treatment, <br /> sta,age; or Uti j i facility accepting tank. <br /> Facility Nates <br /> Na " <br /> Andress: zip: �17GI,' <br /> 3, phone#: 7,Fer- -- - <br /> � _ / ;E <br /> Date Tank Received: � - <br /> - i T <br /> 17fiAt1 ZhV S ATr_.E WD ITL£1I <br />'� xx*x******>z***IIIc***xx****x*,tx�r*xx**xx****�txz.xxcx*xx*t*�irrrrx�rsr*x**xx**IIIc#x*xYxxxst*xx**x**x <br /> Eff 23 049 12/98 <br /> MAILING INSTRl3L' 10NS: POM IN HALF AND STAPLE. AFFIX PROPER POSTAGE, <br /> F <br /> SAN JOAQUIN LOCAL HEALTH DIVIRICT <br /> AM: UNDERGROUND TANK PR0C�2A�f <br /> P. 0. BOX 2009 <br /> STOOC-lW, CA 95202 <br />