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1 SAN JOAQL%MeW LOCAL 'F zr TH �= STRS CT <br /> UNDFRGROUVD TALAR DISPOSITION IrAa:ING RE^.,J'R ) <br /> rrtzrrrz�tYYrs;tYY:r:zzrzrrzz;xzxxzzzazxzzxrrttzxxxxxzzxx;xzxrx xxxxzx*xxxxxtz**zYxzrrrzxz <br /> ION 1 - The San Joaquin Local Health District's Tracking Sheet vill' accompany each tanl: <br /> _fixed vith its site identification number. The Tracking Sheet is tc be returned to San <br /> quir. Local Health District within '30 days of acceptance of the tank, by disposal or <br /> =cy:linc facility. n)e holder of the pericit v+'tr n + te' xioV a s o b'e Eo <br /> - fort 1- comrleted - .e.L <br /> %::Tr 7 r•t NA'E: DOWN RIVER FOREST PRODUCTS <br /> ;Z_T • Arraccc: 1221 N. Golden Gate Ave. Stockton, Ca. 95205 <br /> yN}• Tom. �3C- 0360 - o <br /> [' rixrrXYYYYY YrrYtrrYXYrx!*YY*rrtYtXYtx*lYxtrrttxYXXtXYxxxtxxYYrxx**xxtX;Yx*x*x*XYxX;XXrrrxx <br /> PION - _ - To be filled out by tank removal contractor: <br /> au: Remova: Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> idress: 4 - 1000 N. Union Street Zip: <br /> 95205 <br /> Phone#: �2a� <br /> L lephone: (_Z29— Dclte Tank Removed: <br /> xrttlXYzlYYYXXYfxl;XYx2YrrYrrtxYr2Yxf!lYrrrYlfltltrtrtrYtYr*YxY XX !Yr Ytrx! YsXxxr <br /> :^ION 3 -To be filled out by contractor,"decontaminating tank": <br /> K' <br /> n): Decontamination" Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> `.dress: 1000 N. Union Street 95205 <br /> Stockton, a. Zip <br /> Phone# : �2 " <br /> -thorized representative of contractor certifies by signing below that the tank has been <br /> • contaminated in an approved manner as may be regulated by Department f Health Sery <br /> SIGNATURE AND TITLE <br /> �xxrxrxzYxxzrzrzxrxxxrzxzxxxsxXYtYxrriYXxxzx�exrtzxxxxxzrrrxxxYrrxtxxXrxrY ttxxYYxxYXrrrXx <br /> ':•TION 6 , To be filled outarri signed by an authorized represnetative of the treatment, <br /> orage, or disposal facility accepting tank, <br /> _.lits• Name STOCKTON CONTRACTING GROUP, INC. <br /> Tress: 1000 N. Union Street Zip 95205 <br /> Stockton CA. ---� Phone# : P <br /> _e Tani. R i ved: <br /> AUTHORIZES) SIGNATURE AND TITLE <br /> cxxxxYxYrrxrxxxrxzxxxXxzxxrxXXzrrzxrrxrxxxxxxYY*YzzzxxrX:x Yxrxf Yxrrxxxzxzxxxxxxxxxxxzx:x <br /> 23 045 12/88 ; <br /> _LING INSTRUCTION£: FOLD IN HALF, AND STAPLE. =:IX PROPER POST <br /> SAN JahOUIN LOCAL HEALTH DISTRICT t� <br /> ATTN: UNDERGROUND TAW, PROGRAH MAR 3 1 1989 <br /> P. 0. BOX 2009 <br /> ST Oa TON, CA 95202 ENVIRON,MEt4MLHE�LTN <br /> PERM)TISERVICES <br />