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SAN JO..UIN COUNTY PUBLIC HEALTH S_.�VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PERMIT FOR E OF UNDERGROUND <br /> RDOUS SUBSTANCES <br /> STORAGE TANK S)EXP RES 90 DAYSI <br /> S FROM THE APPROVAL DATE. 00 NOT WRI ERARY CLOSURE OR ABANDONMENT IN C N ANY SHADED AREAS. INDICATE INDIICATE PERM T TYPE. <br /> 12 REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br /> CAD029504743 FACILITY INFORMATION <br /> EPA SITE a L 5 5 PROJECT CONTACT Gggrge Takemc, PHONE* 6-386- <br /> FACILITYNAME A. Teichert & Son Inc. - Stockton ShopPHONE#209-946-86916 <br /> 0 <br /> ADDRESS 103 North E Street <br /> CROSS STREET Weber <br /> OWNEROPERATOR A. Teichert & Son Inc . PHONE# 916-484-3011 <br /> CONTRACTOR INFORMATION <br /> CONTRACTOR NAME Town & Country PHONE# - - <br /> CONTRACTORADOREss3373 Lu un Drive CALIC# 238112 class g- 36 , <br /> INSURER Noack and Dean <br /> WORKER COMP# —61 <br /> FIREDISTRICT Cit Of Stockton PERMIT# <br /> LABORATORY NAME Columbia Analytical COUNTY PHONE# 408-437-2400 <br /> SAMPLINGFIRM Pinnacle Environmental PHONE a 530-676-6884 <br /> TANK INFORMATION <br /> TANK ID# TANK SIZE TANK CONTENTS(PRESENT& PAST) DAE INSTALLED <br /> 39- 1555-05 20 , 000 Diesel 197E <br /> 39- 1555-06 20 , 000 Diesel 197 <br /> 39- 7 --< 17,000 <br /> D(e e * c�IcrzOF, . I`I� <br /> 39- u i t i 0-YA <br /> 39- rS r r, c _ <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 WORK FOR WHICH THIS PERMIT IS ISSUED.I SWILL EMPLOY PERSONS SUBJECT TO <br /> WORKER'S COMPENSATION LAWS OF CALIFORNIA.' <br /> APPLICANTS SIGNATURE TITLE Project Engineer DATE 3-1-99 <br /> ❑ APPROVED 7APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br /> (SEE CONDITIONS BELOW ANO/OR ON ATTACHMENT) <br /> PLAN REVIEWER'S NAME c DATEq <br /> ANY DEVIATIONS FROM THIS APPLICATION MUST •S EMITTED TO END FOR APPROVAL PRIOR TO COMMENCING WORK. <br /> CONDITIONS: <br /> S x' <br /> EH 23 046(REVISED 10/19198) Page 3 <br />