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kf� <br /> j�,. S1AN JOAQU2N LOCAL I-Imo'-2'T•TH 17= STR= CT <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> " SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> 'affixed with its site ,ldentification number. The Tracking Sheet is to be returned to San <br /> Joaquin Local Health District within 30 days of acceptance of the tank by disposal or <br /> "Y" reeycling facility. The holder of the permit with num�r noted below is rPcggnslble for <br /> . "en-ging that this form 1s completed and returned. <br /> FACILITY NAME: / NTt [��es �C i:�✓L e2 V/cFi <br /> ;. <br /> FACILITY ADDRESS: -_ti� 7 �.�Ei�Gd•U T S Cq <br /> TANK IO N39- ' <br /> 8�C1'ION - 2 - To be filled out by tank removal'contractor: <br /> Tank Removal Contractor: <br /> � R <br /> I:ddLesat d � itl� /�.cicil� � `� Zip: <br /> PhoneN �SroZ� <br /> l: <br />