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frtrtfltrttRRttfafaaffllttt 'attlttftattflRf/faaRttttftttf/ )�f-Z�ttttftttr/ftNtttttMt. <br /> affixed 1 - The San Joaquin Tical on lthnum District 08 Tracking sheet will ecCGmpany each ta,. <br /> affixed with its site identification number. <br /> Joaquin Local Health District within 70 da The Tracking Shoat u to b• returned to ga, <br /> recycling facility. npejai of Acceptance of the tank by disposal or, <br /> t'�-LlMI h•t tht - fOZr1 1g 1 ted <br /> ani rAtllr� ted LGIOW is r. for <br /> FACILITY NAME:__ iv/j{9jyIT�// <br /> FACILITY ADuu=;=ll� •� /f'�it1//U <br /> TANK ID M39- <br /> r!:•!.11trraRt.at�,�f�arrrr— e-��Rsaasststaaattarssataaaastaasssssrtftsasssssrssttstr. <br /> SECTION - 2 - To be filled out by tank removalGoatraCtor: <br /> Tar* Removal Contractor i S E M C O <br /> Address: �43j �[�t. Hatrh R gd <br /> 1 -orn A ZIP:_-9535 <br /> Telephone: 209 524-9653e1i;12D9) X4-96' <br /> •!t!!!!R!t!r!R*i`moi!aiR �'� Tam Removed: <br /> rrrarrllRtRrrrrttrlrrrrrrrtrrrrrtrrrurrrasraratautttaatsataartrrr, <br /> SECTION 3 -To be filled out by contract NWcontamlr*tlog <br /> Tank Decontaainatlont contractogj S E M C O <br /> Address: 431 West 'Hatch Road <br /> M UPIi ornia ZS : 95351 <br /> honsl: 0�F3 <br /> Authorized representative of contractor <br /> 2 2 -96" <br /> decontaminated in an approved mortifies by sl9ning below that the tank has been <br /> may <br /> regulated by DoWtaent of Health Services. <br /> flltttlRtRlRlrltltltarftafRfftlRtaRtrft=tratftlt`tIDtftttt�RaatittrtttRat�RRlRRttfit/trfttRaatft <br /> SECTION 9 - To be filled out and signed by as authorized represnetative of the treataa9nt, <br /> storage, or dispoaaI facility tenlc. <br /> Facility Name LEviu <br /> Address: <br /> � 53, 4-- <br /> honeM: f ? C� OAC. <br /> Date Tank Received: <br /> !■! x1R!!lRrrrtrtrttaaaatttt a�f iR t1�i <br /> 23 049trfifDts:Rtltfttttfsfssasftssrtsssststsasss <br /> EH 2J 019 12/89 <br /> MAILING INS•1RLCTIONS: kUD IN HAL;+ AND STAPLE. AFFIX PRWSR Pon".. <br /> AMS LNDMUWJW TAWROGUM <br /> P. 0. BOX 2009M <br /> S'rOQCiGIIa q 95202 <br />