Laserfiche WebLink
SAN JOAQM COUNT? pUBLIC MALTH SERVICES l <br /> V`(VMQNMENTAL K14LTU DIVISION r I <br /> UNDERGROUND STORAGE TANK DI8p0$1 PION TRACKING RECORD <br /> MArAr.rr....rl....sar.lrN rYw wrrr..rr.Arr...rr.lr.rr.. <br /> HCTTQN 1 • Public Healeh $ervleu $nvirotunsntal Health Divlriao Tank Tracking Sheet shell accompany each vele Af&erd with <br /> !'cite Idtodficadon number. The Tank Tml dng Sheer Is to be retumud to Public Health Services Envitnrtmettgi Health Division <br /> !"30 dgvg of acceptance of the tank by the disposal of recycling facility_ The partnit huldcr h 4spoasible for ensuring that <br /> dr(orID 4 completed mA teamed. <br /> 'AGILITYNAME:_IIBERTY FIRE DISTRICT r` <br /> AGILITY ADDRESS:_ 24124 N, B E_L A _R9gp <br /> -AkID#39- TAM SME; SS AI PREVIOUS TANK CONTENTS: 0IE5E1­ FUEL <br /> ........ ale**Nrrr.ale**$rrrr!!l r.ajr...l Arrrr lArrwrrr.rurrrrgrrprw.wwo. <br /> MMON 1+To be fWad out by tahk removal eontreetor: <br /> 'v&Re=valConuactot; JAMES J. HOSLITZELL <br /> tddriss: BOX 30331 City:STOCKTON zip;95213 <br /> Aooe N: 2'0 9 943 7793 pato Tank Rerhoved: <br /> •o ur..prP.Arl.rlH...r..AAlY.rYr....rwrrry.rrll.wrr YY rr.MUH.r.lr76l M.r Hrrrrl.►Mlfr.YYOr...1q.• <br /> I..fON 3 •To be filled out by contractor-"decontaminating tank": <br /> reek`Decontamination Contractor: JAMES J . HO B L I T Z E LL <br /> Wdnas; BOX 30331 City: STOCKTON zip; 95213 <br /> �4ober; ( Y09) 943 7793 <br /> k4oeaed reprosenWive of contractor ccrtifyin6,0vough signswe below that the tudt bu b"n decoetamioatad in en approved <br /> %M!kr u tepulrtd by Cal EPA. <br /> Jana; Tide: Signature: Data <br /> rrHOH..br.r.rlgr!V♦r.b....lr H Hlrr►.rrr.Yr.....wlMlPrMrr V wIr lrprlirrrYrrlp Mrir. <br /> MC7704 4. To be signed and dared by to authorized representative of Na(rtaimaa, storage,or diapoaal faeWty <br /> tiag�tanJ�t o49sd7or <br /> t esr.N� Y <br /> Zip:ltlres : ...�.. — <br /> thdne'I: I�) <br /> )ata Tach Reectved: <br /> Wee; Tide: Sigruaue: Dau <br /> Arr.l.r..rlr..q.J.rq.Y.Np!!�l.r.rYr Y.rrrrYYYYrrLr.rlr.l.rrrM.lrµrrM.p NlNUY!lArrrrr�r YArrrwrrA <br /> RS-4046 (uavued.1tu19198) page to <br /> TO 39trd iSIG 3JId A-Ld3EI-1 9TGZ£££6OZ LZ:80 ZOOZ/tIO/ZT <br />