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VSAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br /> EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> XX REVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br /> EPA SITE # 9813751575 9-e- PROJECT CONTACT 8 TELEPHONE # Gary Haeck PhD. R.G. 916-364-0793 <br /> F FACILITY NAME Newark Sierra Paperboard Mill PHONE # 209-466-7088 <br /> A <br /> C ADDRESS 800 West Church Street Stockton CA 95203 <br /> I <br /> L CROSS STREET Stockton Street <br /> 1 <br /> T OWNER/OPERATOR PHONE # <br /> Y 209-466-7088 <br /> C CONTRACTOR NAME OGISO Environmental PHONE # 510-451-5771 <br /> 0 <br /> N CONTRACTOR ADDRESS 1504 Franklin St St 304 CA LID # 706242 CLASS A-HAZ <br /> TOakland CA 94612 <br /> R INSURER > WORK.cOMP.# 1341233 <br /> A <br /> C FIRE DISTRICT City of Stockton - Fire Prevention Division PERMIT #98-96 <br /> 7 <br /> 0 LABORATORY NAME Chromalab Inc. COUNTY Alameda PHONE #510-484-1919 <br /> R <br /> SAMPLING FIRM Harding Lawson Associates S,- C'L PHONE # 916-364-0793 <br /> 111111111111111111111111 11111 <br /> T 1D # TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> 39- 0II — 6 210.000 eallons Residual fuel diesel X66 <br /> T 39- <br /> A 39- <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> 1I I I I I I I I I III III I I I I 1111111111 11111 1 1111111111111111 11111111111111111111 <br /> P <br /> L _ APPROVED APPROVED WITH CONDITIONS) DISAPPROVED <br /> A (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> N y�'I Q <br /> PLAN REVIEWER'S NAME / f �i &Z� DATE / <br /> I111I I I I 11111111111111111111111111 1111111111111111111111111111 I1111111111111111111111111111111111111111I I I111111111I I I I I I I I I I <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORNIA." /' <br /> APPLICANT'S SIGNATURE: TITLE /"Pa i t OJ L� ,?QZO /DATE q' <br /> CONDITION(S). <br /> Z - V�tn Kms l Cr ct i s Gw �uw w� c ',II 1 5 <br /> A, Y �:2n.w2er�.Q �Aw�L�lK' 0.�et pC�ppUazs:lSlc 5yy'/— AWa� O.,v('�'prv`t'_ �i f. 0�4 , <br /> . ;4 e- A t'cn1- +�J�k'.Y / ��,VT- /�a-�M I�00 l Q�e1r�l•) 9 <br /> ;� �d- bL ^ ..�-I~ _ m� <br /> EH 23 046 (Revised 9/11/gfir- 19 R'f-^^A 47y"�'� <br />