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izauK-i meet wiln): <br /> l accompany each ta <br /> :fixed with its site identification p mlber. The Tracki Sheet is t- be returned to San <br /> touin Lo=al Health District within days of a�eptan_-e of the v disposal or <br /> cycling faci' ity.' 2_holder of the m� .mit * o <br /> t v num no xt PSM b' E <br /> -u fine that this form i completed am ret ,-r>`-. <br /> :r-*mv NAGE: CURRY'S WAREHOUSE SALES <br /> :IL'"^' ADD:2ES': 31�2/7 E. Fremont St. Stkn. Ca. <br /> 000 <br /> tzzxtzxtxxxxztttsxxxzzxztxtxxxtxttzz ztxztttxxz(/txttxttxxtxxtxztzxxxxtxxxxxxxtxxzxxxtzzxx <br /> TION - 2 - To be filled out by tank removal contractor: <br /> j. Remove_ Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> LB "At <br /> ress:- --1000-N.. Union Street Stkn. Ca. e <br /> Zip: 992 <br /> -hone#: 3 1990 <br /> ephone: ( Date Tank Removed: ENVIRONME=NTAL HEALTH <br /> xxxzzztztxxtzxzzttzxtxxt:*zttxztttxttxtxtttizztzxx*xztx*txx***zzxxt*ztxxtx:tz .. VICES <br /> TION 3 -To be filled out by contractor,"decontaminating tank": <br /> Decontamination" Contractor: STOCKTON CONTRACTING GROUP, INC. i <br /> cess: 1000 N. Union St. Stkn. Ca. Zip: 95205 <br /> Phone#: <br /> -)orized representative of contractor certifies by signing below that the tank has been <br /> 3-lt m+ an a ved mannermay be re . <br /> by Department of Health Services. <br /> IGNATM9 AND TITLE <br /> :xttxtxxtttxxxx:xzx tzxzxzxztztx tetxxzzx.txxxxtzxxxxxzxxxxxxtxtxztztzzzxxxxzztxzzztxtxx <br /> 'ION 5 - To be filled out and signed by an authorized represnetative of the treatment <br /> :age, or disposal facility accepting tank. <br /> -lit}• taus ` C� <br /> ess: Zip: 7 <br /> -hone . : 7/K—4RP-Poon <br /> Tani. Received:���6' <br /> AUTHORIZED SIGNATME AND TITLE <br /> xtxzzxzxtzzxexxtxxttxxxzxxxxtxzttzxxxxxxzxxzxxxx:xxxxxxztxxxtxsxxxxtxxzzxxzxxzxxzzxtxtx <br /> 3 049 12/88 <br /> INC; INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTALE. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STCICF,T]N, CA 95202 <br />