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S1�1TN J�IN LOCAL HFar <br /> T ISTRICT <br /> TANK DISPOSITION 'TRACKING RECORD <br /> **k*tkf*#ttk*tkt**!!*k**!#tf#ttkkt#kt#*kkR#lkRkRkk*kk#kklkk#kRlRtkkkk#Rt#**t"kRtlkttRkktk*t <br /> SECTION 1 - The San Joaquin Local Health District's Tracking Sheet will a <br /> affixed with its site identification number. The Tracking Sheet la to be ccOMPai�rnryied�h nk <br /> ta <br /> tan <br /> Joaquin Local Health District within 30 days of acceptance of the <br /> recycling facility. `me holder tank by disposal or <br /> enS�lrirv. F_ - rmit Vi h nenMr h0 a bet.,., is rw; �tii <br /> tet <br /> ed and returned, <br /> FACILITY NAME: I NTf427r49V-E, }�j ray'I ry"pr/ AL, <br /> FACILITY ADDRESS: as' Qf�,/ y a ,.., <br /> TANK ID 139- <br /> *#'1t!!!##**tt**1t*f!*#1t!*#Rltftt*f-�t*R#fR*tkR!ltht#RtlR#fRR*RkRRtt R!lffR!!*t**Rk!#k#Rk*##tk# <br /> SECTION - 2 - To be filled out by tank removal contractor: <br /> Tank Removal Contractor: gyyt CAO <br /> Address: <br /> - X Y L 17 Zip: <br /> Telephone: ( f <br /> —%L, �j Date Tank Removed:__41AL � <br /> SECTION 3 -To be filled out by contractor "decontaminating tank": <br /> Tank Decontamination" Contractor: �E4_r <br /> Address: ��/ )`1N ?-r,4-1 VY)_ <br /> /l/n/3J^Car� ,Q Zip: 3 ` <br /> � Phones; <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved\manner as joy be regulated by Department of Health Services. <br /> *ff*****#**f****fk*fk*k#*#kRtRk*f*##tRttt#NWE#AND <br /> #*tTITLE <br /> t*#*kkR*f*k#kf#ktf#k##f##tk**k**#f*! <br /> SECTION 9 - To be filled out and signed by an authorized represnetative of the treatment, <br /> storage, or disposal facility accepting tank, <br /> Facility Name �/is i <br /> Address: 3 l7 Zip: 3J <br /> PhoneN: <br /> Date Tank Recti ved:_ ZP_41 I Cid <br /> *k**R***f*f****f*#k*kt*f*ktk***#k IZED SIGS*f#I'MmRkAfDkTITLE <br /> kRk#*##k*kkkkkkk#k#k#k#kkkk#k#k <br /> EH 23 049 12/88 <br /> NAILING INSTRUCTIONS: FOLD IN HALF AND STAPLE. AFFIX PROPER POSTAGE, ,;j;,,, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM 111AY 1 9 1989 <br /> P. 0, BOX 2009 <br /> STOaCTON, CA 95202 <br /> [tiVIRONNIEnTAL WEALTFI <br /> PERA!!:f:SGRVICES <br />