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FROM #CITY OF STOCKTON 1999,09-14 09:23 #794 P.02110 Yw SAN AQUIN GUUN I Y YUtluG MtAL I M ,' Wlt t5 ENVIRONMENTAL HEALTH DIVISIOIJ Nr APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PUCE OF UNDERGROUND KQMDOUS SUBSTANCES STORAGE TANK(S) EXPIRES SO DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. ,INDICATE PERMIT TYPE 0 REMOVAL 1 �� Cl TEMPORARY CLOSURE ❑ CLOSURE1N PLACE APPLICANT MUST PERFORM A" WORK IN ACOOROANCE vATM SAN JOAOUIN COUNTY ORDWANCES. S'TATC LAWS, PEOEAAL LAMA. ARO RULa AND REGULATIONS OF SAN JOAOWN COUNTY PUBLIC NEALTN SERVICES. OWNER OR LICENSED AGENTS &WA6 URE CENTIMES THE FOLLOV MM T CERTIFY THAT IN THE PERFORMANCE OF'IIB WORK FOR WI/ICH TWS PMW T IS ISSUEP. 1 SMALL NOT EMPNY ANY POWN N'SUCH A MPANBR AS TO 159COME SUBJECT TO WORKER'S COMPENSATION LAVPS OF CAUFORNW.T CONTRACTOWS MR" OR SUBCONTRACM4 SIGNATURE CERTIFIES THE FOLLOWNIG: T CERTIFY THAT N THE PERFO OF TME WORK FOR VWICH THIS PEIWR IS ISSUED, I SHALL EMPLOY PERSONS SUBW[TTO WORKER'S COMPENSAnom LAWS APPLIGANT'931GNATURE TRLET=+T OAYE (SEE CONDITIONS BELOW ANOIOR ON ATTADINENII PLAN RENIEWER•S NAAM__f DATE ANY DEVIA71ONS FROM THIS APPLICATION MUST Be SUBWTTgD TO "FOIL A►PROVAL PR1OA TO gamm MMe WORK. // CONDITIONS, Coln CONTRACTOR INFORMATION FACILITY INFORMATION BrotheraInc.PHONEf921L-43-02 'EPASITEf pgOJECTCONTACT Ron Palm uiat PNONEf 204-937-8320' I NAME ADDRESS j5ioex UatewaY Project noundeay EafayeLre, - El Dorado, Center and PHON f Sonora Street" CROSS STREET 39- 39- OWNER OPERATOR Redevelo meat Agency of Stockton PHONE APPLICANT MUST PERFORM A" WORK IN ACOOROANCE vATM SAN JOAOUIN COUNTY ORDWANCES. S'TATC LAWS, PEOEAAL LAMA. ARO RULa AND REGULATIONS OF SAN JOAOWN COUNTY PUBLIC NEALTN SERVICES. OWNER OR LICENSED AGENTS &WA6 URE CENTIMES THE FOLLOV MM T CERTIFY THAT IN THE PERFORMANCE OF'IIB WORK FOR WI/ICH TWS PMW T IS ISSUEP. 1 SMALL NOT EMPNY ANY POWN N'SUCH A MPANBR AS TO 159COME SUBJECT TO WORKER'S COMPENSATION LAVPS OF CAUFORNW.T CONTRACTOWS MR" OR SUBCONTRACM4 SIGNATURE CERTIFIES THE FOLLOWNIG: T CERTIFY THAT N THE PERFO OF TME WORK FOR VWICH THIS PEIWR IS ISSUED, I SHALL EMPLOY PERSONS SUBW[TTO WORKER'S COMPENSAnom LAWS APPLIGANT'931GNATURE TRLET=+T OAYE (SEE CONDITIONS BELOW ANOIOR ON ATTADINENII PLAN RENIEWER•S NAAM__f DATE ANY DEVIA71ONS FROM THIS APPLICATION MUST Be SUBWTTgD TO "FOIL A►PROVAL PR1OA TO gamm MMe WORK. // CONDITIONS, Coln CONTRACTOR INFORMATION CONTRACTOR NAME Evans BrotheraInc.PHONEf921L-43-02 CONTRACTOR ADDRESS 75139 Nation4l Drive CALICf 443GISCWSA a2 INSURER State Fund 1 WOKkERc2t!430-98 PIR QIjMICT LABORATORY NAME The Twining Laborato71e9, I Fresno PHONE► 559-260-7021 IRM Tha Twining Laboratories, Inc. PH-zbO-7Uzi APPLICANT MUST PERFORM A" WORK IN ACOOROANCE vATM SAN JOAOUIN COUNTY ORDWANCES. S'TATC LAWS, PEOEAAL LAMA. ARO RULa AND REGULATIONS OF SAN JOAOWN COUNTY PUBLIC NEALTN SERVICES. OWNER OR LICENSED AGENTS &WA6 URE CENTIMES THE FOLLOV MM T CERTIFY THAT IN THE PERFORMANCE OF'IIB WORK FOR WI/ICH TWS PMW T IS ISSUEP. 1 SMALL NOT EMPNY ANY POWN N'SUCH A MPANBR AS TO 159COME SUBJECT TO WORKER'S COMPENSATION LAVPS OF CAUFORNW.T CONTRACTOWS MR" OR SUBCONTRACM4 SIGNATURE CERTIFIES THE FOLLOWNIG: T CERTIFY THAT N THE PERFO OF TME WORK FOR VWICH THIS PEIWR IS ISSUED, I SHALL EMPLOY PERSONS SUBW[TTO WORKER'S COMPENSAnom LAWS APPLIGANT'931GNATURE TRLET=+T OAYE (SEE CONDITIONS BELOW ANOIOR ON ATTADINENII PLAN RENIEWER•S NAAM__f DATE ANY DEVIA71ONS FROM THIS APPLICATION MUST Be SUBWTTgD TO "FOIL A►PROVAL PR1OA TO gamm MMe WORK. // CONDITIONS, Coln TANK INFORMATION ANK lb f TANK SIZE TANK CONTENTS (PRESENT 6 P OA IW ALLAD 39- g n - W. 1,060 eal EMI)tylunknown 39- 39, 39- 39- 39- ' APPLICANT MUST PERFORM A" WORK IN ACOOROANCE vATM SAN JOAOUIN COUNTY ORDWANCES. S'TATC LAWS, PEOEAAL LAMA. ARO RULa AND REGULATIONS OF SAN JOAOWN COUNTY PUBLIC NEALTN SERVICES. OWNER OR LICENSED AGENTS &WA6 URE CENTIMES THE FOLLOV MM T CERTIFY THAT IN THE PERFORMANCE OF'IIB WORK FOR WI/ICH TWS PMW T IS ISSUEP. 1 SMALL NOT EMPNY ANY POWN N'SUCH A MPANBR AS TO 159COME SUBJECT TO WORKER'S COMPENSATION LAVPS OF CAUFORNW.T CONTRACTOWS MR" OR SUBCONTRACM4 SIGNATURE CERTIFIES THE FOLLOWNIG: T CERTIFY THAT N THE PERFO OF TME WORK FOR VWICH THIS PEIWR IS ISSUED, I SHALL EMPLOY PERSONS SUBW[TTO WORKER'S COMPENSAnom LAWS APPLIGANT'931GNATURE TRLET=+T OAYE (SEE CONDITIONS BELOW ANOIOR ON ATTADINENII PLAN RENIEWER•S NAAM__f DATE ANY DEVIA71ONS FROM THIS APPLICATION MUST Be SUBWTTgD TO "FOIL A►PROVAL PR1OA TO gamm MMe WORK. // CONDITIONS, Coln