Laserfiche WebLink
. . �3f+.hl .JCjf�1. i 1 tJ 1..•. 'f�L, liEf�.L,'!VI' U1 �:'172SCT <br /> UNDE3iU•'-tJt4 PNlV L': :.: !..t4 IVA, !N'; I<Eux <br /> **#kFRX*#FF*#fiX*#FXX**XfiFF#***X#*XX*fiXX.X*. . A .* .Xrt**Xfi*xX*fifiX*fiXk#*fixfiR*X*Rfi■RFKFFF KKKtKFKF <br /> 9DCTION 1 - The San Joaquin Local Health District 's lrackinq Sheet will accompany each tank <br /> affixed with lts•site identification number . The Ttacking Sheet is to be returned to San <br /> Joaquin Local Health District within 30 da :: of acceptance of the tank by disposal or <br /> recycling facility. 1'he h l of tt _ S-��r ,, <br /> t nsurino that �--�� 1- 111_ LQY-1.i_ oo rbi f <br /> — hl forn 'te �lr�LrS �!1551�. <br /> nr <br /> FACILITY NAME: Nor-Cal <br /> FACILITY. 1 " <br /> .800 "c , <br /> 1 . <br /> TANK ID N39-_ _-- j— �OD Caw V. <br /> AX***********X*A'*F*#** .***AA . AAAA . . A . AA *.A .AAA. AAX*##X XXfifiXRX#fiKFKKFKFKKF KKt�•KFF Y <br /> SIXTION - 2 - 'Ib be filled out by tank remv. . _ contractor : <br /> Pank Removal Contractor : <br /> Andress: <br /> .._— Zip: 9565b <br /> Telephone : ( , ) _ Date Tank Removed : — 916-652-5535 <br /> _ <br /> **#*fi*F*FF***#XfiXfiFF*F*F*FFFXF#fi#AXfi#*fi***A..xX*fifi###fiXXrtR#/rXRRRRfi*F#F*R#*FKKKFKK FFFKKKKFXX <br /> SECTION 3 -To be filled out by contractor "decontaminating tank" : <br /> Tank Decontamination" Contractor : <br /> Address: P• Box i t, Zip; 95650 <br /> ---- _Phone N : <br /> Authorized represen ive of contractor certifies by signing below thXit the tank has been <br /> deconta ated 1 ppro nn� as may, cr re ulated by Department of Health Services. <br /> S1CAJAI!'F.E D TITLC — <br /> Ax*X#FFX#FF*XXX A'fiXX*fi XfiXAAXA .. X*Xfix*XX . ..fifiX'XfiFx#XA XfiXA'xXk#FR■*XX Xfi XXFF#KMKRKK KK•KKKFR <br /> 3IXTION 4 - it d out and signed by ar, authorized re-presnetative of the treatment, <br /> storage, or disposal f I, Ity accepting taco. . <br /> Facility Name LOW —_ <br /> Address : <br /> .__ PhoneN : 46 33 <br /> Cate Tank Received: <br /> XX*FfiFFFF*##*#**#AFF#R*kFR#fiXAA*AR*X AAXXX AAIA ..XXAAAA*XAX* AXA *RFRX XXXA XXFxF**F�RFRR KKIt>tR**# <br /> Flt 13 049 11/88 <br /> HAILING INSTRWrIONS : GOLD IN HALF AND Sl,%% LL. AI-TIX PROPER POSTAGE:. � <br /> SAN JOAQUIN L:x'Al HEALTH D1S'MICT <br /> A'M14 : JNDM=7(-XJND TANK PR,X7:N1 <br /> F 0. BOX 2C i'';• <br /> STOCXTON, rf LV. <br />