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FROM : TA IT & ASSOCIATES – Sacr to FAX NO. : 91663526L6 [liar. is 1999 11:08AM P11 <br />SALN JOAQUIN COUNTY MBLJC kWALTH SERVICFS <br />ENVIRONNMWAL HEALTH DIMON <br />UNDERGROUND STORAGE TANK DESPOSITION IRACIONG RECORD <br />TT T-TTTTT.TTTTM -T,T, TT=M, <br />WJM�krk -7 <br />Ers Site Wcw&wadon nuatber, ne T21* Traclems Shect is to be murzed OD Public Hcalth Scnices Ewimmewal Healdi <br />wftAft 30 don of acceptswe of the tank by the dispmal or reqating fmilky. The permit bakitr is rter; ponaffik for ensuring that <br />this fmm is completed and reumned. <br />FACUTY A.DPMS- <br />TAINK ID #39 - TANK SIZE: MEVIOUS TANK CONTENTS: <br />VII <br />E=WP,�451Tg <br />-SECIION 3 To be ffled by contraclor "decomombnating tmkll: <br />TWA DeeontaminaAan 0mvactor-=M7 %-Nmlli�kom li&k)AN�- NM KLM <br />Addms- 9,5C) Za <br />city ���Azip- I <br />Phone 9- 4 <br />SECTiON 4 - To be sigacd and dawd by an authorized repres=tative of We utaxnama, swW. or disposal facaky <br />accepftg wink and/at p04. <br />FAOLVy Name: <br />Address: Z3p: <br />Fbm 1: <br />Due Took Received; <br />Name- Tide:— Dam <br />