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` SAN JOAQU LOCAL Tzar.•I+H 1I'F2= CT <br /> r <br /> UNDERGROUND TANK DISPOSITION TRACKING RECORD 5y I�1y <br /> r:sr::x:ttrt*jt/�¢ssX:x#xsrxxxz:xxxx:x:xx:xrXX�sixsxxxxzxxzxxxxxzxxxxsxxxXx*std#ids x <br /> E:TION 1 - 7 Sa'n Joa ih Local Health Districts Trackino Sheet will accompany � <br /> f qui <br />-ffixed vitaq site identification number. The Tracking Sheet is tc be itureach <br /> Joaquin.• Local Health District within 30 days of acceptance of the tank by dispo54 /6 WCES � <br /> recycling facility. n2t holder of the <br /> permit v ' h n lov i= s nisi o f <br /> e u--inc that this form is c le ed and return-_d. \' <br /> ACILIn NAME; STOCKTON CONTRACTING GROUP, INC. 2Z /EQ <br /> ACTLT"^ ADDRESS <br /> �. 1000 N. Union Street Stockton, Ca. 95205 <br /> _�--�—^ <br /> IL. 09- <br /> zzxxxX*xxt*t*t frr**xxXtxXxxt*xxtX*xx reXxxxXx7on ECTIOU - 2 - To be filled but by removal tractor: <br /> Removal Contractor: STOCKTON CONTRACTING GROUP, INC. <br /> ^dress: 1000 N. Union Street Stkn. Ca. 95205 <br /> Zip: <br /> Phone#: 462-5082 <br /> lephone: ( ) Date Tank Remo <br /> LkLtrrxxrxrxttx**xx*xxxxxx*xrxX**t*xxxxrxxlr*trxtr*trtsxx Xr*xx *xt xr x#* ** txtxltrxxR <br />`pECTION 3 -To be filled out by contractor " ta <br /> decWmi tank" ; <br /> lan): Decontamination" Contractor: Stockton Contracting Group Inc. <br /> dress: 1000 N. Union St. Stkn. Ca. Zip: 95205 <br /> Phone#: (gnq) 669-_ ,QR2 <br />,uthorized representative of contractor certifies by signing below that the tafik has been <br /> econtaminated in an approved manner as may be regulated by Departmen of Health Servi . <br /> SIGNATURE AND TITLE <br /> zx*xxxsxztxxxxtxx:xxxxr*tzxxxxrxsxxxxxXsxxxsxxx*xXtxxrxsxxxxxxxxxxx*xxx xxxxsxxxxxxzxx*xxx <br /> E^TION 5 - To be filled out and signed by am authorized represnetative of the treatment, <br /> corage, or disposal facility accepting tank. <br /> acility Name Stockton Contracting Group, Inc. <br />; :rens: 1000 N. Union St. Stkn. Ca. Z1 95205 <br /> Phone#: (209 + 2�C18r <br /> ate Tani. Receiv <br /> ezxszx*xx*xxstx:zxrxxrxxzxzxsxr`xxxOxRxxxx*xtzxzxxxxxR*Dxxx*T*xsxxxx*xxxxxxz zs*xsx*zxxxxxxxsr Vrr, <br /> 23 049 11/88 <br />?LING INSTRUCTIONS: F= IN HALF AND STAPLE. AFFIX PROPER POSTAGE. <br /> SAN JOAQUIN LWHEALTH DISTRICT <br /> ATTN: UNDERGROUND TANK PROGRAM <br /> P. 0. BOX 2009 <br /> STOCG , CA 95202 <br />