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ttv tvIt: tt :tttfftt: RECEIVED <br />►PPLICIT10Y FOR PERMIT r SIN JOIOUIN LOCAL HEALTH OISTIICTt: <br />t: UNDERGROUND TANK t: 1608 E HIIELTOY ►PB., STOCKTON Clt: NOY 2 1 1989 <br />C CLOSURE OR 111NDOYMIIT F telephone 12011 168-1120 ti MRONMENTAL HEALTH <br />rKy. It. It: it: I:tl�tt.tvItIII: tt.etvit: ttitt.tt.' It: t;.9"1:11. R:tatt.it: tl-'R.ItInt:It: PERrvllT/SERA; L -S <br />1PPLIC/TION FOR PBRMINKIMEMPORIRT CLOSUII OR 181NDONMENT 11 PLACE OF UNDERGROUND HAZARDOUS SUBSIIYCRS STORAGE FACILITY <br />THIS PERMIT EXPIRES 10 DIPS FROM THE APPROVAL DATE. DO NOT Y11118 IN 111 SHADID AREAS. INDICATE PERMIT TYPE BELOW: <br />/ERNDWIL __ TEMPORARY CLOSURE _ 181100NM8NT IN PL1CI <br />EPI SITE I CAG OpO226617 <br />PROJECT CONTACT 1 TELEPHONE I RAY JETT 239-0208 <br />P FACILITY MIME CONTEL <br />1 <br />PHONE I (209) 239-0208 <br />C IDDRESS 17855 S. COMCONEX, MANTECA, CA <br />I <br />L CROSS 511111 AVENUE 120 <br />I <br />1 OWNER/OPBRITOR CONTEL <br />1 <br />P10Y11 (619) 245-0457 <br />C COYTIICTOR 111111 GROUNDWATER RESOURCE <br />0 S, INC. <br />P1011 1 (805) 835-7700 <br />Y COYTR/CTOR ADDRESS 5400 ALDRIN COURT, BKFD <br />CA BTC 1 520768 <br />CLASS <br />T <br />A <br />R INSURER STATE FUND I <br />NOl1.COMP.1 793569 <br />1 <br />C FIRE DISTRICTPERMIT <br />i/ZYSTTI <br />T 0�_ .� <br />0 LABORATORY IAMB B C LABORATORY <br />PHONE 1 (805) 327-4911 <br />R <br />SIMPLIYC FIRM' SAMPLING METIOD <br />y� R RESOURCES DOHS <br />TIMI ID I TINL 5121 CHIMICILS $t ORED PRY'IIOUSL <br />} <br />/ 19-_-��� - 1 0 al. Gasolin_ <br />_ <br />Y 19- - 00 al. Gasolin <br />jeE_ <br />I ]T <br />_ LIST ADDITIONAL ?INK INFORNIt10K 15 NRBDID OY SEPARATE FORK <br />WWYWYRIY611WWWNY �' DWYWiBWWYIWIWYY'lIWl"JY71111�I4!WWWIYYWWIIWYh'YWR!7Lll.YfItlWWWYY7tLIluJDL'JR'U2L'OIWnWRIJYWJWWWIW7RIiWIIWIIIWGWW�tl;;LL WW1IWIlW11WNIRWW94 <br />P APPROVED <br />_APPROVED WITH CONDITIONS DISAPPROVED <br />L <br />(SEE ITTICYMIYTTTY COSDITICYS) <br />I PLAY RIVIEVERS MIME IX <br />1PPLICIYT MUST PERFORM ILL YORE If ACCORDANCE WITH SIN JOIOUIM COUNTY OIDINIYCES, STATE LAYS, IND RULES IND RECUL1tIONS <br />OF THE SIN JOAOUIY LOCAL YIALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CERTIFY ?III? <br />If THB PERFORMANCE OF THB WOIK FOR WHICH THIS PERMIT IS ISSUED, I SHALL lot EMPLOY Ail PERSON IN SUCH MINNER 1S t0 BECOM <br />SUBJECT TO WORKER'S COMPEYSITION LAYS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SICIITURE CERTIFIES THE <br />FOLLOWING: '1 CERTIFY "IT IN THE PERFORMINCI OF TI16 PORI FOR WHICH THIS PERMIT IS ISSUED, I SHILL EMPLOY PERSONS SUBJEC <br />TO YORKER'S COMPENSATION LITS OF CALIFORNIA. <br />CALL FOR INSPECCTTI�ONS AT LEAST 40 HOURS IN ADVANCE <br />IGNBD <br />- -�— <br />OFFICE U$I OILY --NII 17 016 11/1I ---� --- <br />SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS <br />YEIPS I I COMP I LOC CODE DIST CODI�—IMOUYT DUSI AMOUNT RCVD - CKI/CASU -I- RCYD BY I DIYI RCVO_ - PERMIT I <br />