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05/10/99 09: 18 RU 425 251 8782 BARGHAUSEN '92003 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVMSION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> TY15 PERMIT ORPGF MNE'�Ci7TaAPORARy CLOSIJRl:OR ASANOONMENr W RACE OF UM B CRCK-WO HAZARDOUS SUBSTANC-s <br /> 5TORAGc TAiK(S)EXPP--S 90 DAYS FROM THE APPROVAL DATE DO NOTMV rM IN ANY SHADED AREAS. INOtCAi c PERMIT TYPE <br /> I <br /> AR MOVAL ❑ TEMPORARY CLOSURE C1 CLOSURE IN PLACE <br /> FACILITY INFORMATION <br /> SPA=Tr=ar PROJECT CONTACT ZV &I�� PHONE1t Z /-(p 2 Z Z <br /> F E L`O 4/17/A;31Fl1G PHONE t 2c�j <br /> AOORESS I —"fo E. - A44?;N r k14Y -,S:Glx 7-8A/ -2a 5'f zo <br /> { CROss tgRE2 ZT Go iiLr2 Si <br /> o :oPE Aron PHONE 4 -7i &-70-�4 <br /> I <br /> CONTRACTOR INFORMATION <br /> c Aczo�NAME. . Fc7nE2 eya,� Ilvc. PHOt x 9zs- ss/- 7944 <br /> cUtlTwi�,roi A00P Ss E j` `" Ca LIC a Z2 07 CLASS 8 /f <br /> IrFstJF R M.4rSccv 6KW-e7L. WORKER COMPik <br /> RRE 01STmc Gi �vf% ►�, PER ATs <br /> OR toftl�NMAE ' s'-. UW fT/ CowryPHONE <br /> SAMPL1iylG FIRM PHONE � <br /> u <br /> i I TANK INFORMATION <br /> TANK at TANK SIZE TANK CONTENTS('RESENT& PAST) DAT-4%SSTAL ED <br /> 39- 151 1,2 a!)v `TZg- <br /> 39- ; Zf Z 6L�X' -r - <br /> 39- <br /> 39- j <br /> 39- <br /> �.. <br /> APM3CA*M PERFQRM A LI-WORK IN�MTH SAN JOACAM C MTY OR00W(U.STATE UWS,F wekAL tAyws,Aso WLFs ANo <br /> REGULATTONS pF SAN JDAM w COUNTY PUW-X HHALTH SSS o MM; pR UC94SM AGefrs=NATIRtF-cFsrnaEs-tW FOIJ-OwW_ -1 l <br /> COCnFY TI IAT IN Tt 8 PSRF0R&"MCE OF TFC ti40RK FOR WHICH TM PF T M tSS=,i SMALL NOT I3APLOY AMY PERSON W SUG?t A MAIFNF�2 AS <br /> TO BECOME SUBJECT TO NIOR2�7t'8 CJMP'B<ISA710N tAYYS OF CJALWOP-W&- CONJRACTOFM H*UNQ oR SUa0W4TFZACnNG S;GrIATURE C7RIvIft f" <br /> THE FCLLOWIH4: COY 7}iA.T 7THE WORK FOR YAtKC!THIS PERIAT tS C=Go.I SIMLL EUF*.,QY PERSCMS ZUWE- T > <br /> WORKEE S P=LAM <br /> 1::A ORNUL <br /> APPLICANT'S TrrL-c 1 oyr.¢i—c lJr DA i <br /> C3-APPROVED• 0 APPROVED WITH CONDITION(S) G DISAPPROVED <br /> (S�Co*axr$om BaGWAMIOR Ott ATTACHMEWQ <br /> Ip-It-AN REZAEw��rS NAU>_ 41- <br /> cait= j �5 <br /> ANY D"TIONS FROIK THIS APPt3CATION:MUST BF SUSAMITT'ED TO EHD FOR APPROVAL PMOR TO=MMe4C:NG WORK. <br /> CQNOITiONS_ <br /> t <br /> t Z3 G46(R>=VISF=0 1Gil 9M) 3 <br /> r) av � CI <br />