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DEC- 6-95 WED 14:38 KLEINFELDER FAX NO 2099480621 F. iu/Gu <br /> ENVIRONMENTAL HEALTH OIVISION <br /> APPLICATION FCR UNOERGaCUNO STORAGE TANK CLOSURE PEAMIT <br /> TANK <br /> IN PLAE <br /> APPLICATION <br /> FOR <br /> EXPIRES DAYS H64T �CMTTHCSURE OR E AP9ROVALACATETNM00TACT WRITE OIN ANY SNAOED ARE - tUDICATETPETNEIITTTYPEEaFLCW: <br /> IS <br /> REMOVAL TEMPCRARY CLOSLRE - CLOSURE IN PLA C= L� [ /�,�7­ <br /> PRC.ZCT CONTACT 0 TELEPHONE 10A 1/ ) /�O (Q U� <br /> EPA sI�E : 6D <br /> �T 7xcNE � <br /> FACIL:TT NAME meg- �fF/✓R <br /> AODRE33 S, ! QYJ W <br /> CROSS STRUT <br /> 7WNf9/OPERATOR <br /> "Z o ' - 60 <br /> PHONE <br /> CONTRACTOR NAME <br /> { CONTRACTOR AOORESY`3 <br /> �� — CA LIC 7 Z ` CLASS <br /> 41CRK.CORP.. <br /> { INSURER �dt$v f•eR..►—'� PERMIT Y <br /> • <br /> '!AE OISiR]CT �p <br /> PNCNE S LU p/ <br /> { LABORATORY NAME 1, PMGME A C9ib - �6 73 <br /> I <br /> i SAMPLING ?I LS 1 111"•11 TANK SIZE CH ( l3 5T0 ED " REHTL /PREVIOUSLY GATE UST_jNSTALIEO <br /> ANK ID '1 /fJbyCR7G7o�//•- �� <br /> 39• <br /> T 39. <br /> A 39- <br /> 39- <br /> 39- <br /> 39. <br /> 9•39•39-39• <br /> 39• <br /> 1111 111 I fill 111 11 1111 1111 III fill ill !II <br /> 111Illi III II1 111 I ]III 111 1111 <br /> 7 1APPROVES WITH CCNOITIONCS) D(SAPPRCVED <br /> L APPROVED <br /> A (SEE ATTACHMENT JUN CONDITIONS) GATE <br /> N PIAN REVIEIIERS NAMEIIIII <br /> tI1I1111I1111IIIIIII CANT MUST PERFORM ALL WORK IN ACCORDANCE WAND RULE'a AND REGULATIC..3 OF <br /> APPLIITH SAN 1CAOUIN =_CUNTY GRO!HANCES• STATE LAWS, <br /> FOLL <br /> rr <br /> SAN .CAOUIN COUNTT Pu0.lIC HEALTH S'eRVLC'e 5. euNER OIS O <br /> R LIC MSED IASHALLSX SIG AT TAN YURET PERSONTItN SUCHOAI MANNER]AS TO EECOMET IN <br /> THE PE3FORMAMC'E OF THE WORK FOR WHICH THIS 7 iM!T IS CNT I SHALL !'PLOT PERS-MS <br /> -t SUE.ECT TO 'WCRKER'3 <br /> SUS:ECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. CONTRACTOR'S HIRING CR SUSCONTRACTIN9 SI ONATUAf CERTIFIES THE FOLLOW :I <br /> C•RTIFT THAT IN THE PERFORMANCE OF SHE WORK FOR 'JN ICN THIS PERMIT IS [15LE7. <br /> CCHp£NSATIGN LAWS OF CALIFORM •� <br /> TITLE ��� A'OASE <br /> APPLICANT'S SIGNATURE: <br /> Page 3 <br /> EM 23 046 (Revised 4/26/94) <br />