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v <br />err <br />M' . 1 .A L��. <br />This form Is to be -, to San Joaquin• District r days • <br />acceptance of tank(s) by disposal or recycling facility. The holder of the perml <br />with number noted above Is responsible for ensuring that this form Is completed <br />returned. <br />* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SDMCK 1 - <br />Address: Phone # <br />Zip <br />Date Tanks Removed No. of Tanks <br />*********************************** <br />•. ,,, r'' 14, • <br />. MITETTITMW <br />r- • rr r • •y <br />Address Phone# <br />Zip <br />Authorized representative of contractor certifies by signing below that tank(s) <br />has(have) been decontaminated in an approved manner as may be regulated by <br />Department of Health Services. <br />* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * <br />SBMON 3 - To be filled out and signed by an authorized representative of the <br />treatment,, storage, or disposal facility accepting tank(s). <br />Facility Name <br />Address • r <br />Zip_ <br />Date '- • r of <br />1 V 'A ZOVO!Wj CeZ. 7 -,1V-7!70 403 <br />MILING • • • in half and staple.Aff ix proper postage. <br />EH N XX WP\TRACSHT.LET <br />