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SALV 1J01WZ1LJIN LOCAL FI Ar.T;A DISTRICT / <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD <br /> !XflflYit*!tt#ititltt***XXlXXlXX*!X*tlXYY!!flYYYYYYXYfXlfYlYlXXYlX*X*X*XX*!#*t#*XtlXtfft!*# <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will accompany each tank <br /> affixed with its site identification number. The Tracking Sheet is to be returned to San <br /> Joaquin Loral Health District within 30 days of acceptance of the tank by disposal or <br /> recycling facility. The holder of the permit with number noted below is responsible for <br /> ensuring that this form +s completed and returnee <br /> FACILITY NAME: COLLINS ELECTRIC CO?IPANY <br /> FACILITY ADDRESS: 611 W. Fremont Street <br /> TANK ID #39-��-�_ <br /> **Y!!**!*X*f XX*XXXlX*f!ltXYX*XlXXYfXY**XYYXYXtXlXXXlXXXtzXXXf*XXX!*X*!!tX!*Y*XXX*XXXXXXXlXf <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> Address: 1000 N. Union Street Stkn. Ca. 9505 <br /> Phone#: <br /> Telephone: ( 209 462-5082 Date Tank Removed: <br /> *XX*X!!X**tX*!***XYX!*XYXXXtX******XfiXXt*X*!!tX**i*XYX***!ltft!*XYt!**XXYX#XX**X****tXY!!f <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> Address: 1000 N. Union Street Stockton Ca. Zip: 93205 <br /> Phone#: (209) 462-5082 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved manner as may be regulated by Department of Health Services. <br /> SIGNATURE AND TITLE <br /> zflYYlXzlXYXlXX!*XYXXX!!XX!!XXlXftizzlzzffzX*!zX*YzrXtzz!lXix**XX*!X*zXXxzlXtxX!*XXXlxfzsiz <br /> SECTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank. <br /> Facility Name Stockton Contracting Group, Inc. <br /> Address: 1000 N. Union Street Stkn. Ca. Zip: 95205 <br /> Phone#: (209) 462-5082 <br /> Date Tank ived: <br /> AUTHORIZED SIGNATURE AND TITLE C H d N Ulm U <br /> EH 23 019 12/88 <br /> MAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95202 MAR 81 1989 <br />