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F, <br /> TANK DISPOSITION <br /> TRASXI.►fC Rw]O3RD <br /> SECTIO{ I - The San Joaquin Local Health Distrirt.s Tracking Sheet w111 acro <br /> affixed with its Ml.ta <br /> identification number. The Tracking S <br /> Joaquin Local Health District within 3A da sof beet Is to any Pato tar <br /> recycling facility. Y acceptance Of �' returned to Sar <br /> the tank by disposal or <br /> FACILITY NAW; <br /> a AGILITY ADA MS. <br /> TAM rD t39- c�q I y Al <br /> SECTICN - 2 - To be filled out b]+ tank removal <br /> contractor: <br /> flank F�e=val Contractor; 5'E�t cv <br /> Address: `3 rt'� Are, <br /> Telephone: -:Z <br /> *Rx �#* *##Aatat##***#emov ***4##x$E#lti7tRaP#st# <br /> �]fg Tank Removed: <br /> SECrICN 3 -To be filled out b. <br /> contractor "decontaminating tznk1t: <br /> Tank Decontamination"•contractor: <br /> Address: <br /> .. Phoney Zips <br /> Authorized representative of contractor certifies by signing <br /> decontaminated in an approved manner as be below <br /> Y regulated b that tl:e tank has been <br /> I' �P�tment of Health Services. <br /> RRxxa,rry�a$*sxra*#*A�y**R*xR*s#kk*#p*#*#**sGNA A-RE AiYArrt* <br /> D TYTITITL.E <br /> 31x-"PION 4 - To be filled out and signed by an authorized xepresnetative of the txez <br /> storage, or disposal £aclllty �ptinq tank. <br /> .tment, <br /> Facility Nam, Aj <br /> Address: p S <br /> Date Tank Received. Phone#: ------ <br /> A <br /> -----A *AND#TITLe x**� <br /> Sit 23 949 12/88 <br /> MAILING INSTRUCTIONS.----.-- <br /> FY3t,D....IN-HALF- <br /> t+ AI7IX PROPER POSTAC�; <br /> Lam, <br /> SAN JOAQUIN f=LAr DISTRICF <br /> AM: -UNDIIt[,'RaMD TANK PROGRAM <br /> P• C• AOX 2009 <br /> SMCXTONi CA 95202 <br /> w y 468.3460 <br /> 468.3283 <br />