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• SAN .70AOU, . LOC T. •FimAr ,rH <br /> UNDERGROUND TANK DISPOSITION TRACKING RECMD <br /> rrzs:szzxztxxttxsttszxxtxxxstrxxxxxzrxxxtzzszti�rxxxxxxxrxxxxxzxxxxxxxzxxxxxxtzztttzxzsxxr <br /> DM ON 1 - The San Joaquin Local Health District's Tracking Sheet will'accompany each tank <br /> Efixed with its site identification number. The Tracking Sheet is to be returned to San <br /> Paquin Local Health District within '30 days of acceptance of the tank by disposal or <br /> =cycling facility. The holder Of tbg permit with numj&r noted below is responsible <br /> 159.rinc that this fors i_ completed and returned. <br /> =ILI Y NAME: CURRY'S WAREHOUSE SALE$ <br />;GILT"^_' ADDRESS: 3(1227 E. Fremont St. Stkn. Ca. <br /> UZ: ID tis-- �J / - U ( �1144OU *It4�1 — OIL ;Wtxle�� <br /> crxxxxxxxzstxxtzstzzxxxtxtxxzsxzztsxxxszxxrxxzxxzxx zxxxxx*xxzxzxxxxxxxx xzxxxzxzxxzxtxzxx <br />::.TION - 2 - To be filled out by tank removal contractor: <br /> Removal Contractor: STOCKTON CONTRACTING GROUP, INC. <br />(dress: 1000 N. Union Street Stkn. Ca. Zip: 95205 <br /> Phone#: <br /> lephone: ( ) D-te Tank Removed. <br /> xxxttxxttttxxxtx:tttttttttttxtxxttttxtttxxtttttxttt*xtxxtttxtxxtttx:txxxxxxtt::tzs::sxtxx <br />:'TION 3 -To be filled out by contractor,"decontaminating tank": <br /> nk Decontamination" Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> dress: 1000 N. Union St. Stkn. Ca. Zip: 95205 <br /> Phone#: <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 of Health Services. <br /> SIGNATURE AND TITLE <br /> xxxrsxx*xttxxsxxrxxxtsx:rzt:xtxttxttisxxxxzrzx:txzzxxzzxxxxzxxxxtxxxxxxxtzxxxsxxxttsxx:zx <br /> BION 5 - To be filled out arra signed by an authorized represnetative of the treatment, <br /> Drage, or disposal facility accepting tank. <br />=ility Name TRIANGLE INC. <br /> Tress: Sacramento, Ca. <br /> Zip: <br /> Phone#: <br />_e Tani: Received: <br /> AUTHORIZED SIGNATURE AND TITLE <br /> cxxzzxxxxsxsxzszxxszstxzxx*xx*xxxzx*xzxxxtzxxxxxzxxztxzzsxtxxxxxz*tzxtxxzxzxzxxzzxzxtrsxr <br /> 23 049 12/88 <br />:LING INSTRUCTIONS: FO..D IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 <br />