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f <br /> SAN. .JC3Z-�Q�N LUCAL� I-�AL,TH �I STR2 CT <br /> UNDERGROUND TANK DISPOSITION TRAWING Rr <br /> rrxz:rxxrxrxxzrYxzzr##xxxrrzxxxxxxY*xxz:rxxzzrxs#xxxxxxxxxxxxxxxxxxxxxxxxxxx*#,txxYzr*xrrrrxx <br /> SECTIO 1 - 'The Sar; Joaquin Local Health District's Tracking Sneer will accompany each tank <br /> affixes vi0 itz site identification number . The Tracking Sneer is tc be returned to San <br /> Joaquin Local Heath District within 20 days of t <br /> acoe p tax►=e o_ `hy tall}: by d:s Cosa,_ or <br /> rezycling facility. Tht hgI.Qr 00 ibe- berI'ityytnymbe; holt'" veigy tic rp n 6 p <br /> enfu"nc ba' _his form, i.e roma Ere' ant regu t _ 5 _S_ JiL �_L�_ <br /> - - nev <br /> F C TTY NAME: CASECO AUTOMOTIVE <br /> z17LITY ADDREFc: 1025 E. Park Street Stkn. Ca. <br /> - <br /> xxrxxzxxxxxxxxxzrzzzxxrx:zx-xxxxzrzxxxxzYYzxxxzxxxzxzxxxrxYxxxzxxxxxxxxxxxxxxxxxxxxxxrxxxxxx <br /> 2 - To be filled out by tank removal contractor : <br /> STOCKTON C0N`7RACTINC GROUP INC. <br />;��: Removal Contractor: . <br /> Address: 1000 N. Union Street Zip: , 95205 <br /> Stockton, a Phoneh (2093 <br /> 462-5082 <br /> Telephone: ( 209 . ) 462-5082 <br /> Date Tank R.em&ed <br /> xxxYr*Yx*zYxYZY**z**Y*Y1C7t 7rYYYYszxxzrYxzzzxzzxxxYY****zx7YxZxYxxtxxYx#zYYY*xz*zzzzzxzzxYZZY*x <br /> SECTION 3 -To be filled out by contractor "decontaminating tank" : <br />^ank Decontamination" Contactor; Stockton Contracting Group <br />%dress: 1000 N. Union Street 95205 <br /> �)LOCKton, a Zip: <br /> hone : (209) 462-5082 <br />,arborized representative of contractor certifies by signing below that the tank has been <br /> iecon:.aminated in an approved manner as may be regulated by Department of Health Services. <br /> SIGNATURE AND TITLE <br />-xxzxzrzxrxzxzxzYxxxxz**xxzz*xxxx*zxxxxzxxxx�Yzr*trxzxxx*zxxzxxxzzxxxxxzxxxY*xzxz**zzxzxzYxz <br /> ACTION 4 - To be filled out and signed by an authorized represnetative of the treatment, <br />.forage, or disposal facility acceptin,q tank . <br /> Wilily Nair Stockton Contracting Group, Inc. <br /> + �yY <br /> rens : 1000 N. Union Street <br /> toc on, Ca. Zip: 95205 <br /> Phone o : 1 462.-5082 <br /> AUTHORIZED SIGNATURE AND TITILLE <br /> xxxxxxzxxzxzzxxxxxYzxzxxxxxzxxxxxxxxrxxYxxxxxxxaxzxxYxxxxzxzxxzxxYxr*xxzxxxxxzxx*xxxxxxxzx <br /> !INC <br /> 049,f[_'+�2�/s 6 ry�T FE <br /> y LTA T r}#} <br /> IT!INC WS_!\SUCTIONC: C LD IN fir.LL� � STAPLE. AFFIX PRC=.`E OSTAGE. <br /> SAN JGOUIN LOCAL HEALTH- DISTRICT <br /> ATTN: UNDERGROUND TANK PRGKRA.M. <br /> P. 0. BOX 2009 <br /> =CKTON, CA .95202 <br />