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SID TAMC DISPOSITION TpMXINa RD iD <br /> !!#f* <br /> :S©L"IION 1 - The San Joaquin Local Hsalth Districtes 7hraclking Sheet Will #!*� <br /> 'affixed with its site identification nuiber. The Tracking Sheet is to a nytank <br /> Joaquin Local Health District within 30 days of acceptance of the tank <br /> recycling facility.. by disposal or <br /> FACILITY NAME: t=- kit) . <br /> FACILITY ADD ZSS: r' <br /> TANK TD 639- <br /> SECTION - 2 - To be filled out by tank rewval contractor: <br /> Tank Removal Contractor: S E M C 0 <br /> Address: s . Hatch Road! <br /> t C 1 "forma Z1P�_ —95351 <br /> Tele 209 524-9653 '�e#' 5 4- 653 <br /> Telephone: ( ? r4_ Date Tank Removed: <br /> SECTION 3 -To be filled out by contractor "dix=ta+aigating tanks; <br /> Tank Decontamination" Contractor= S E M C 0 <br /> Address: 431. West •Hatch Road, <br /> Modes C Iifornia Zi 95351 , <br /> 2 4-9653 <br /> Authorized representative of contractor certifies by signing below that the tank has been <br /> decontaminated in an approved mannex as say be regulated by Departwnt of Health Servicea. <br /> GMlTUREAM!*#*TIME <br /> x!*#l�t�r#�!lal�rlf!!�*�t*##e+�#*!*s�t�!** <br /> Ski rION 4 -- To be filled out and signed by an authorized repreanetativee of the treatment, <br /> storage, or disposal facility aonpting tin*. <br /> Facility Name_ S E M C 0 <br /> Address: Ha t c1 1Ro 5-3.51 <br /> �pl estoCal'fornia r�#ZiP ,�3 <br /> Date Tarek Received: <br /> RR#****RR##RxR7tR##R*##t#eta#st,els��f#!�#*flGNAfTLM:#AND <br /> #TITLE <br /> EH 23 019 12/68 <br /> MAILING INSTRUCTIONS: FUZ IN HALF AM STAPLE. AFFIX PROPER pOSTAM. <br /> SAN JOAQUIN ED= HEALTH DISTRICT <br /> ATIN: LNDUMOM TAW PROMM <br /> P. 0. BOX 2009 <br /> STOOMWO chi, 95202 �. <br />