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.700rocza, H TH 01 S I CT <br /> UNDERGROUND TANK DISPOSITION TRACKING ROCOM <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> 1 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 holder of the permit with number noted belov is responsible for <br /> ensuring that this form is completed and returned <br /> FACILITY NAME: Lawrence Livermore National Laboratory - Site 300 <br /> FACILITY ADDRESS: 15 miles east of Livermore on Route 1, Tracy <br /> TANK ID 139- `/ 7,� - 874-D1Ul) <br /> LLNL ID �� 874-11D � <br /> tt**ttt*tttt*tt*tttiter*tttttt*ttttttttttttttt****tit*�*ttttttttttttttttttttttt*tttt*ttttttttt <br /> SECTION - 2 - To be filled out by tank removal contractor: ' <br /> Tank Removal Contractor: GSE Construction Company, Inc. <br /> Address: 2402 Research Drive ZIP: 94550 <br /> Livermore, CA Phone#: (415) 447-0292 <br /> Telephone: ( 415 ) 447-0292 Date Tank Removed: June 271 1990 <br /> t*txttttt*ttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttt <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: Tank with Contents shipped as non-RCRA Hazardous Waste <br /> Address: w 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 /> See Uniform Hazardous Waste Manifest #90271625 <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 /> Richmond, CA Phone#: (415) 235-1393 <br /> Date Tank Received: October 10, 1990 <br /> See Uniform Hazardous Waste Manifest #90271625 <br /> AUTHORIZED SIGNATURE AND TITLE <br /> ttirtttttttttttttttttttttttttttttttttttt:ttttttttttttttttttttttttttttttttttttttttttttttttttt <br /> EH 23 049 12/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />