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SAN JO")UIN COUNTY PUBLIC HEALTH S`RVICES <br /> bAVIRONMENTAL HEALTH DIVISICh1 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br /> STORAGE TANK(S) EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE: <br /> 13 REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br /> FACILITY INFORMATION <br /> EPASITE# CAC 002132605 PROJECTCONTACT Am' Plomteaux , Es . PHONE#'(209)367-6992 <br /> FACILITYNAME Sari Tomo Partners PHONE# <br /> ADDRESS 11291 N. Alpine Rd. Stockton CA 95212 <br /> CROSS STREET Live Oak Rd. <br /> OWNEROPERATOR San Tomo Partners PHONE#(209)948-0792 <br /> CONTRACTOR INFORMATION <br /> CONTRACTORNAME ilm Tliorpe Oil , Inc. PHONE# (209)368-6175 <br /> CONTRACTOR ADDRESS ox J CA LIC# 495699 CLASSA $ HAZ <br /> INSURER emper GenStar WORKERCOMP# 1095135 <br /> FIRE DISTRICT PERMIT# upon approval <br /> LABORATORY NAME roun ero Argon Labs COUNTY SJ PHONE#(209)838-9888 <br /> SAMPLING FIRM lirounct zero PHONE x (209)838-9888 <br /> TANK INFORMATION <br /> TANK ID# TANK SIZE TANK CONTENTS(PRESENT& PAST) DATE INSTALLED <br /> 39- 6 000 gal Aviation Gasoline 1992 <br /> 39- 4 ,000 gal Jet Fuel 1984 <br /> 39- <br /> 39- <br /> 39- <br /> 39- <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS. FEDERAL LAWS.AND RULES AND <br /> REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENTS SIGNATURE CERTIFIES THE FOLLOWING: 'I <br /> CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS <br /> TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE RK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKER'S COMPENSATION LAWS OF H' IA.' <br /> APPLICANTS SIGNATURE ITLE Contractor DATE 12/3/98 <br /> ❑ APPROVED [7'APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br /> (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> PLAN REVIEWER'S NAME DATE S 9 <br /> ANY DEVIATIONS FROM THIS APPLICATION MUST BE SUBMITTED TO EHD FOR APPROVAL PRIOR TO COMMENCING WORK. <br /> CONDITIONS: <br /> / C6osul.E GEr.E,� Gar] m: f3c iSS�E� v,lri i96L /4a�L P.wv ?v'�9 <br /> 2� So c �ig.�r/�CF�7�/p5T/'�,4 [ 'rte✓�A'rA s-n� cc�'ri F a/� wSo9ar��i' <br /> EH 23 046 (REVISED 10/19/98) Page 3 <br />