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A <br /> • -, ( SAN. JO�,f2�N LOc^•nr . . xF'z�r .TH�IS`I'F2ICT <br /> INDERGROCND TANK DISPOSITION TRACKING RECORD <br /> rxrrr:xzrrrzrrzrprxrrxr:xrxzrrrzzrxxrrzxxxxxrrrztrrxxxxzrxzxxrxzxxrrxzr*xrxzxzrx ice � <br /> SECTION The San Joaquin Local Health District's Tracking Sheet t,•iil acc ��e�c�i'rank <br /> affixed with i` site identification number. The Tracking Sheet is to F&''Edfned to San <br /> Joaquin. Local Health District within 30 days of acceptance of the tank by 440sal o- 9 <br /> Yid <br /> re;vclina facility. F +t vi'th n lov tis pl <br />_su inc that this Form' i= completed arr sP �* \ <br /> FACILI'I'�• NAS: CASECO AUTOMOTIVE <br /> FACIL'^� pcc: 1025 E. Park Street Stkn. Ca. <br /> __ ADIYL.. <br /> TAN}: IC t35-��? - <br /> xxrzxxsxxrzrzzxxzxxzxxrxxxx•rxx�zxrrxxzxxxxxxxxxrx:xxxxxzzxxxzxxxxrxxzxxzxzxzxxxxxxzxz <br /> SECTION - _ - Te be filled out by tank removal contractor : <br />:aril Removal Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> Address: 1000 N. Union Street Zip. • 95205 <br /> Stockton, a i Phone#: (2C <br /> 462-5082 <br />-elephone: 209 _ 462-5082 <br /> rxxxxxrxrxx:xxxxxtrrrrxxrxrrzrxrrxrxzxxxxx�xtexrTank <br /> xRemoved: <br /> xrxxrxrxxxxxxxxxrrxrrxzxrxxrzrxx <br /> 3EC7ION 3 -To be filled out by contractor "decontaminating tank" : <br />^ank Decontamination" Contractor: Stockton Contracting Group <br />�d9ress: 1000 N. Union Street 95205 <br /> oc on, a Zip <br /> Phone#: (209 <br />,uthorized representative of contractor certifies by signing below that the tank has been <br /> iecortaminated in an approved manner as may be regulated by Department of Health Services. <br /> SIGNATURE AND TITLE <br /> xxxxxxxxxxzzxxxrx:xxzxxxrxxxxxxxxzzrxxxxzrxlrxxxrxzxxxzxxxxzxxxxxxxxxxxxxxxrxzxrxxxxxxxxrzz <br /> r ' ION 4 - To be filled out and signed by an authorized zepresnetative of the treatment, <br /> torage, or disposal facility accepting tank. <br /> acllity Name Stockton Contracting Group, Inc, <br />..dress: 1000 N. Union Street <br /> auucKuufl, Ua. Zip: 95205 <br /> Phone# : (_091 <br /> R=•Y_�e� �a <br /> r = <br /> AUTHORIZFJ SIGNA7LRE AND TITLE <br /> vxxxxxxrxxxxxxxrxxzxzzxzxxxxxxxxxxxxzxxxxxxxxzrxzxxrxxxxxxxrxxxxzxxxxxxxxxxxxxxxxzrzxxxxr <br /> 22 049 :2/88 <br />-_TLING INS'12X IONS: FpZ IN HALF AND STAPLE. AIFFIX PROPER POSTAGE. <br /> SAN JOAOUIN LOCAL HEALTH' DISTRICT <br /> ATTN: UNDERGROUND TANK PROMXv.. <br /> P. C. BOX 2009 <br /> CA •95202 <br />