Laserfiche WebLink
a 11 1 <br /> ENVIRONMENTAL HEALTH <br /> SAN 30AUIN L-C"='^3[` HMAJL"* r'>XSWR:NgVr 81989 <br /> UNDERGROUND T DISPOSITION TRACKING <br /> P R IYSERME <br /> s:sxssssxsxsxxxxxssxsssxssxxxxxsxxx:xxxxsxxssxssxsssxxsxxsxssxxxs:xsssssssxsssssssssssss ss <br /> SWrION 1 - The San Joaquin Local Health District's Tracking t will accompany each tank <br /> affixed with its site Identification number. The Tracking Sheet is to beeetur disposal to <br /> San <br /> J in 1 alth District within 30 days of of <br /> the tank by or or <br /> recycling facility. hol•11 <br /> = of the nrwit vi h n * t low is r ril __ <br /> FACILI NAME: Lawrence Livermore National Laboratory <br /> FACILITY S:15 miles east of Livermore on Route 1 Tra <br /> T ID 139- - LLNL IN 801-R2U1 (801-31R) (SJCounty Tank #2) <br /> xxxsxID #39 xssxx:xxxsssxxxsxxxxxxxxxxxsxxxxsxxsxxxxxxxxxxssxxxxxxxxxxxxxxxsx ssxsxxxxxsxxxs <br /> SWrION - 2 - To be filled out by tank removal contractor: <br /> RemovalTank Contractor: <br /> Addcess: Zip: <br /> P #: <br /> Telephone: t ) Date Tank Removed: <br /> xxxxssxxxxxxxxxxxxxxxxxxxxxxxxxxsx*xxxxxxxxxxxxxxxxxxxxxxxxxxx*xxxsxxxxxxxxxxxxxxxxxxxxxxxx <br /> sWrION 3 -To be filled out by contractor "decontaminating ": <br /> Tank Decontamination" or: <br /> Zip: <br /> Address: Po #: <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved nner as may be regulated by Department of Health Services. <br /> SIGNATURE TITLE <br /> xxxxxxxxxxxxxxxxs**xxxxxx*� **xxxxxxxxxsxxxxxxxx�xxxxxxxxx*xxxxx*x*xxx**xxxxxxxxxxxx***xaxx <br /> SECTION - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name <br /> AddZip: <br /> rens: Phone#: <br /> Date Tank Received: <br /> AUTHORIZED SIGNATURE AND TITLE <br /> xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*xxxsxxxxxxxxxxxxxxxxxxxxx*xxxxxxxx*xxxxxxxxxxxxxxxxxxxx <br /> SH 23 049 12/88 <br /> ILI INSTRUCTIONS: FOLD IN STAPLE• IX PROPER POSTAGE. <br /> SAN JO IN LOCAL HEALTH DI ICP <br /> A TANK PROG RAM <br /> p. 0. BOX 2009 <br /> STOCK7oN, CA 95202 <br />