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SAN aoAQUIN LQ AT-'I'H LSI S I CT' <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <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. Tba b9lder gf the 29ralt with numbu adcdo <br /> 20=109 that this fo,Am I& ggn ,jcted and re&ur <br /> FACILITY NAME: MEL BOKIDES PETROIaM, INC. CARDLOCK NUVIBER 2 <br /> FACILITY S: 983 MOFFAT 'BLVD. MANTECA, CA. <br /> TANK ID #39- <br /> SECTION <br /> 39-S ION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: PRECISION INDUSTRIES, INC. <br /> Address: 1041 S. PERSHING AVENUE Zi 95206 <br /> Phone#: P209T_WZ-_99M' <br /> Telephone: ( Date Tank Removed: <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: <br /> Address: Zip: <br /> Phone#: <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> SIGNATURE AND TITLE <br /> SECTION 9 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name ERICKSON INC. <br /> Address: 255 PARR BLVD. Zip: 94801 <br /> Q% Phone#: _(415) 235-1393 <br /> Date Tank Received: <br /> AUTHORIZED SIGNATURE AND TITLE <br /> Sit 23 049 12/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> A UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />