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EN'VIROIilMEPIrAI HE 1 Th <br /> 94 MAy 13 PH 2: 001-4 <br /> L ' LLj98 <br /> uta <br /> ENVIRON E HEAJ}{ <br /> ENVIRONMENTAL HEALTH DIVISION PERMIT SE <br /> VICES <br /> APPLICATION FOR IADERGROL 0 STORAGE TANK CLOSURE PERMIT <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IM PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br /> THIS PERMIT EMPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IM ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> —.l REMOVAL TEMPCKARY CLOSURE __ CLOSURE IN PLACE <br /> EPA SITE t CAD 982051781 PROJECT CONTACT i TELEPHONE t John Lynch ( 209) 833-0758 <br /> "- 'A; FACILITY RuhE�racy Joint Union High School District _ PHONE / ( 209 ) 831-5032 <br /> C ADDRESS 315 E. 11th Street Tracy , CA 95376 — <br /> 1FCROSST East Street <br /> 1 <br /> TTOR PHONE 0YPublic Srhoo] s Anne Bell ( 209 ) 831-5032 y� <br /> C <br /> COI TRACTOR WANE Wright Environmental Services, Inc . A PHO£ 0 ( 209 ) 833-0758 <br /> j T CONTRACTOR ADDRESS 1961 Hill View Wary, Tracy G LIC f b>15U1 _ CLASS A , B , HAZMiA'I' <br /> If R INSURER Adreini Company & Workman ' s Comp. WORK-COMP-8 1312649-93 <br /> APERMIT Y <br /> L FIRE O15TRiGT CO_Tracy _ N/A <br /> I 51 ) 846-3188 <br /> 0 LABORATORY NAME CKY Environmental/S ar er Tech . PHONE I ..�� <br /> fI P g I 91 3ti2-RQd7 <br /> MPLING FIRM Wri ht Environmental PHONE U ( 209) 833-0758 <br /> /� IANIDJY� TANK SIZE CHEMIULS STORED CURRENNT'Y/PREVIOUSLY DA119n INSTAI�ED- 1 61967 <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> L? <br /> 9-39-IIL APPROVE APPROVED WITH CONDITION(S) DISAPPROVED <br /> A (SEE ATTR NMENT WITH CONDITIONS) <br /> N PLAN REVIEWERS NAKI �ir� DATE <br /> lunnnnllnuullimT �� TfTTiTfTTTTTITTtmTfTTInIImTTTTTtTTT' m <br /> APPLICANT MUST•.PERFORM ALL WORK IN ACCORDANCE WITH SAM JOAGUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENI'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY TINT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SWILL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WOR[ER'S COMPENSATION LAWS bF CALIFORNIA." C'ONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> "1 CERTIFY THAI IN THE PERFORMANCE OF THE WORK FOR VHICH THIS PERMIT IS ISSUED, 1 SMALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> iCOMPENSATION LAVS OF CALIF 1A.• <br /> APPLICANT'S SIGNATUREN TITLE O. iG� esti \ DATE I Z 1 <br /> v• <br /> * Old Transportation Facility <br /> `I <br /> EH 23 OAb (Revised 7/10/92) Page 3 <br /> 1 /� <br />