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� , ME y q . .� 51' <br /> J - <br /> sAkJ .70AQU.TN Iw,OCAL HZKAr_,T'H bI TRI C'I' <br /> WDEkGROUND TANK DISPOSITION TRAMINt3 RDCQrcD <br /> SECTION 1 - The San Joaquin Local Health District+s Tracking Sheet will accompany each task <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• The h2lder of the permit with number nnrp �a isrQ4� fr <br /> fi?f4P is ,gamleted-and returned. o <br /> -0 <br /> FACILITY NAME: SMES RWAL <br /> FACILITY ADDRESS: _ TRACY, CA, 95376 <br /> TANK ID 139- y -� - <br /> AA**A!**Fs3*'A****A*Afl'A***YtlA9k****$***AA**f�**�i}$*11fA�t**!*!*!Ak*R**fiR**iF!#**R3lA*#*�pA*A*{th#AAAlh <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor:S Z ,�Q1MML CONSTRUCTION CG-PANY _ <br /> Address: - 2S9 IC_UMM-r DR VE SAN JOSE CA. _ � p: 95M-4133 <br /> r � Phane�: 408 <br /> Telephone: t 408 ) 997-1505 Date Tank Removed; <br /> #*** <br /> SECTION 3 -To be filled out by contractor "decontaminating tank"! <br /> C: ink DecontMiration" Contractor: !�&H SHIP SERVICE <br /> Address: 220 4ZTN IZAMRAPICISCO CA. zip;94107 <br /> Phortelit{415} 5l3AMS_ <br /> Authorized representative of contractor certifies by signing below that the tank has beers ' <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> SIGNATURE AND TITLE <br /> SECTION 4 To be filled out. and signed by an authorized represnetative of the treabwnt, <br /> storage, or disposal facility accepting tank. <br /> Facility MW H&H SHIP SERVICE <br /> hddresst X220 CHINA BASIN SM FRAfVCISM": <br /> ` -- _zips 91107 <br /> Date Tank .Recelved: <br /> AUPHORIZED SIGNAT[.AIE AND TITLE <br /> =, Fit 21 049 .12/b1 <br /> `ICING WS4RUCTIONSt FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> f <br /> SAN JOAQUIN LOCAL HSAL TH DISTRICT <br /> ATM. UNDERGROUND TANK PROGRAM <br /> P. o. BOX 2009 <br /> STOClKTIM, CA 95202 <br />