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w yy •yyram� ���� yy y ,+ , s �^ y * r ^s ^4 y� q� g _} � r� ^� �p y t� g ♦^y�y- <br />4 !t :} I:'!..!_tl A.! 1,..J e� «1L •1.,'f � t't.✓ �M�•'b.A�.e L -T ^ems � I✓ w�4. A:.A vJ,'+.'R..L ee.o .i.� <br />VOL) MCKM ThNK DISPU"SITI(Al 'il ACKINC t1=- -*W <br />,*ikAA*Afr**##Ahft*Aft A* *kkAst*; **fth**rirr4*A***ithrk***** tNftk**AA ft*****Aft**a1**ARRA* <br />dW"VION I - The San Joaquin Lrxal Wealth 01st:rIcLIe TLacking Sheet will accompany xwach tank <br />alflxed with iLa s1te identlficatrioat sunitk l . The Tracking ,Sheet 10 to be caLurjj,---(j to Seal <br />Juaquln Local ltealt:h D.i,t.rlc.t; wAthin 30 clarrc of acceptance of the tank lay (11sros3al o <br />recycling facility. <br />wns:,,r a no t l,:aa- 1•reS c fnrm ase r•lint 1.).i ail :at,. I <br />nn 1 1 <br />FACILITY NAME t/LqA_w-fr r I M <br />i ACI LXX X MAW S:....«.71G-_.� r/o <br />TAM Ip <br />6*AAAA*AAA1tW#iY#AcAAAkA#AAAAAkk 0 Ak**AAA,1*it Achrtrrrtk 4 * A k* 0 A A it A A x I% * A A It KRA it A A <br />St^X.• 1CX•t - 2 `To be filled oul: by tank re.uioval c:ontrar. s <br />cj:�a4 .0 <br />TaM Removal CortUact:ox s <br />C," <br />hxlarmes: r c� �%P� a•,�., _ _ ri,: 58g2� <br />TdlYph0f*s t.[ X1,40.1: 1917.0 --.—Efate Tank <br />*kit ii#ki�rf,V�pp;�r*Akk*kA*9rrtk�brtkR�V Arst�ri4AfiKk�tAtYA�r�rt�*ct�:rrUki4t�at*st9:A*finfefrftts�rkhtthrtikilstri�tl:Ak�rtrrthri�rkAA*k#k <br />8fik,'kla4 3 -'i'v be filled out by contractor "oecontaminat:ing <br />Tank Decdut:aminat#on" Contractor., <br />AddreuS: 0a ox 179 S arr2`'�xip: 5ff2 3 <br />AuLhorixed representative of voiltrac Lor c er:t:i,flss by signing bolow tiv-at; tehc= 1:.,ar,k tees baa:n <br />decontanAnated pan app 1W.tr►rter a m -ay be z:ac,Itat.ated by Depaxtjprnt of llealLh Uarvices. <br />i3iLVINIURN' AND TITLE <br />kRhR:Yh�triRAlr�rhYt*A1c*1Sir�r*1►itAtthAkhlkhkllk*hhAirYtkkAAhitA�t�h•Rath►IA�rAk3crk:tlkAfiAAflAlt�kfr.kWhAhikhk�lJlAk'A•rtty*AA}t <br />BF;C.'`PIUN 4 - TO to filled out: awl signed by ,art aut:horized n1presnet:at;i.ve of the txeataant, <br />at:oxage` or: di:3gosal fac l t.y accepting bank, <br />Facility fume ►�. Leif ii e �fC, _C� ��tc <br />Address: %592 <br />�?1 �� • 2%- l t�° G <br />Date 'Tank fte sd I o , <br />re <br />----«.-..._.......................-..........wn........,. <br />At ri'tlatai ZED 131 GUAIME AND THLx; <br />it�tA#AAhrt#Erik*ithsti4Air>ir*�,kActtAAAA*ttirAA#AA#N�CRilficYkAJcrkMrit�h�e�!*A�aAkA�titAAr#*�tAiri4*irAAAtY�kyt�cAh&rt Ac�t.k�k#k�i#* <br />Ell Ia 049 12/80 <br />1441LItW I@aS•jRUCrjoN$; TOLD IN Il1t P ANI) SiTApLZ, ApFIX pjj()ppji poST.ACE,, <br />SAN JOAQUIN LOCAL ttir: L111 DIS7Mer <br />P.*.*O. WA 2009 RECEIVEL <br />8'1W,1tA4 j CA 95202AUG 2 <br />7 10"01 <br />! ENVIRONMENTAL HEALTH <br />,,`� <br />PERM ITYSERVICES <br />