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EMVIRONMENIAL HEALTH DIVISION <br /> APPLICATION FOR UNOERGROUNO STORAGE TANK CLOSURE PERMIT <br /> APPLICATION FOR PERMANENI/IEIIPORARY CLOSURE OR ARANDONMEMI IN PUCE OF OlInElUROINID NATARDOIIS SUBSTANCE STORAGE TANK <br /> IIIIS PEAIII EXPIRES 90 DAYS FROM 111E APPROVAL DATE. 00 x01 WRITE IN ANY 9HADED AREAS. INDICATE PERMIT TYPE BELWI <br /> X REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br /> EPA 11IF B CAC 000737776 PROJECT Cd11AC1 A IF.LEPIONF E Don Rodgers (209)465-7515 <br /> F UCIUIY RARE Don Rodgers PHONE / (209)465-7515 _ <br /> P. ADDIM11 550 W. Charter Way Stockton, CA 95206 <br /> 1 --_- _-_.......-- <br /> L C"OSS "TIM Lincoln St. <br /> I <br /> otnlFR/orERATDR Don Rodgers PHONE 0(209)465-7515 <br /> T <br /> C CONIRAf.IOR MAIZE JIM TNORPE OIL, INC. PHONE 120 )368-6175 <br /> N COMPACTOR ADDRESS 351 N. Beckman Rd. , Lodi, CA 95240 CA LIC "495699 GLA"A. B. Naz. <br /> t — <br /> R IIISIIAF.R Landmark & Genstar WORK.COMP./ <br /> A — <br /> C TIRE. DISTRICT The City of Stockton PERMIT IT Uoon aonroval-oL1lar <br /> I _. . __. _____ <br /> 0 LAnORAIORY RAVE. GeoAnalytical Laboratories PHONE I (209)572-0900 <br /> R <br /> FAI'111PG ,IPMPHONE • <br /> — IIIIIIIIII��III��l�lllllllllll GeoAnal tical Laboratories - <br /> nQno <br /> NK IA SI2E CITE CAl S ORED C NTLY/PREVIOUSLY DAY WI INSTALLED <br /> !p. 550 galons eaxdea gaso�ine <br /> t lv--- <br /> A !9- <br /> N lv-- <br /> k 19--- — <br /> !9- <br /> � 11111111111111111111111111 III II IIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII111111111111111111111 IIIIIIIIIIIIIII111111 <br /> l rROVEO APPROVED VII„ C0II91110N(9) DISAPPROVED <br /> R (SEE At IAC@IENI WITH CONDITIONS) DATE <br /> IIIIIIII111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 <br /> ArrLICAHI MST I'MORM ALL M)Rk IN ACCORDANCE VII" SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOArAll" COUNTY PUBLIC HEALTH SERVICES. MIER OR LICENSED AGENT'S SIGNAIIIRE CERIIIIES TIIE FOLLWINGI "I CERTIFY THAI IN <br /> IIIE PERtOAHAIICE OF TIIE WORK TOR WHICH IRIS PERIIII IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER Al 10 BECOME <br /> SU"JECI TO WORkER'S COIIPENSAtION LAWS OT CA1.IFORRIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNMURE CERIIFIEB THE FOLLOUINGI <br /> "I CFRIIFY THAI IN 111E PERFORHANCE OF THE WORK TOR WN IRIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT 10 WOAKEN'B <br /> CUIPENSAIION LAWS OF CAL ITURNI " <br /> APP1.10111'9 SIGNATURE, DATE 1/23/96 <br /> lit 23 046 (Reel Red 4/26/94) Page 3 - <br />