Laserfiche WebLink
• - t tt f;t,a t�'ttdt.At t ti tt gtdt it tt n klt,"e NttlTatt C'A; <br /> t-, t APPLICATi TOR PENH t SAN JOAQUIN LOCAL HEALTH b,, <br /> { ONDERGROUND TAN: C 1601 E HAJELTON AVE., $TOC#TON CA 1, <br /> G CLOSURE OR ABANDONMENT p Telephone UU9) 468-3410 r, <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAIARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EMPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS, INDICATE PERMIT TYPE BELOW: <br /> XX REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> 1 j EPA SITE 1 CAD 009109844 I PROJECT CONTACT f TELEPHONE I F;reo (209) 466-2041 <br /> 1 F FACILITY NAME Puregro Company PNO <br /> NE 1 (209) 466-2041 <br /> C I ADDRESS1904 W, Charter Way, Stockton , CA <br /> j L CROSS STREET Fresno Avenue <br /> T OWNER/OPERATOR Puregro Company PHONE 1 (209) 466-2041 <br /> Yi <br /> ° C CONTRACTOR NAME Jim Thorpe Oil , Inc PHONE 4 (209) 462-4581 <br /> N hCORTRACTOR ADDRESS 351 N. Beckman Road _ CA LIC 1 495699 CLASS A, Haz. <br /> R INSURER on file NORK.COMP.1 on file <br /> P I FIRE DiSTPiCI San Joaquin )PERMIT IIiNSPTR <br /> T - -- ---L__ <br /> O I LABORATORY NAME FfL Environmental PHONE 1 (209) 942-0181 <br /> R _T �____. __ . -- <br /> SAMPLING FiRNt same _ SAMPLING METHOD Brass Tube-See f5 on removal plan <br /> TANK 10T <br /> AW SIZE CHEMICALS STORED CURRENTL CHEMICALS STORED PREViOUSL <br /> A1 ----------------- <br /> 39 �� �—� 1 ,000 Unleaded aas <br /> , <br /> N1.2.0-00 Unleaded gas <br /> Y34 <br /> ------------­------------- <br /> (y ------ <br /> ._ _ <br /> R ?9�. ------- . <br /> ttl LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> P _ PROVED APPROVED WITH CONDITIONS ____ DISAPPROVED <br /> L EE ATTACHMENT H CONDITIONS <br /> A PIAN REVIEWERS NAME _ lil/� pATE__ <br /> N - - ----------- ..1--- � <br /> m <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RUII.S AND RLGuLAT10NS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWINr.; 'I CERTIFY THAT <br /> iN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, I SHALL HOT EMPLOY ANY PERSON iN SUCH MANNER AS TO BECOMI <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING, '1 CERTIFY THAT iN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT iS ISSUED, I SMALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COtlPENSt1Ti0N LAWS OF CALIFORNIA. <br /> V <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> S <br /> gST6fED <br /> Vice _Presid-en-t-- ------- DATEI2/90 <br /> ------_------- -- - _____FR I016 II118 7j <br /> Sts{f{1{14fff1{fff{ff/14/4fiffffflftiff4fff{ffiffff4ffffifff4i f{ffl{St{1{iflllitfftf{ittHffff{tfi{4ff4Sttf ISI f$/1ftf11Sff <br /> 4"�WLEPS 1 COMP 1 ILDC CO➢E IpiSi COOED ANOUNTDDUEJAM-PUNT RCVO CK11CASH.J. RCVDBSL ATE RCVD , PERMIT 1 <br />