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VzF-ri KU'.1 F+. <br /> J <br /> SAN JOA UIN COUNTY PUBLIC HEALTH SERVICES <br /> Q t)G7 � <br /> t�Iit 19, <br /> vatONPolai'CAL HEALTHDIVISION 98 <br /> ?APPLICATION FOR UNDERGROUND STORAGE TA1:VIC CLOSURE PF�1 TXT- . <br /> THE PERMIT FOR PERMAMENT{TEMPORARY CLOSURE OR ABANDONMENT tN PLACE OF JNDERGRO°JHC HAZARDOUS 3USSTANCfEa�TORACFALTA" ,K <br /> ERPIRES 90 DAYS FRCM THE APPROVAL DATE. JO HOT 'WRITE IN ANY SHADED AREAS. INDICATE PERMI' TYPE BELOW: `AJq <br /> REMOVAL TEMPORARY CLOSURE __ CLOSURE IN PLACE y,,. {� y •� <br /> j EPA SITE # ( �.(� G7�J .1` 4J�2Jd PROAEOT CONTACT 4 T£LEPXCNE # N./j J/�/Q, �7 p 5 G__-L <br /> I F I FFAC:LITY NAMES /L/,/fr{ PHONE #- �'%� <br /> I C W RE3S 7-5-fro W 11� <br /> •CROSS STREET C�,Er 5 MA'iA.,l <br /> T j OWNER/OPERATOR J ,• '- � vQ 20. T9 PHONE a .� vC� <br /> fl //JJ /� <br /> i C CONTRACTOR HAMS %�/ ].r 1(22 i(JA-� PVONF- $'j Z - Z`F/G7 <br /> N CONTRACTOR ADDRESS / 7 (,:i'4 UL/ y� r• �. CA LIC t 7 21Y( i CLASS /.`J.!Z <br /> R :NSVRlR �y(JL e-' //✓SU,44AJCE CA'J /T' r /W I✓I� WRK.L.7'NP.,Y <br /> A ' llf--- <br /> C FIRE PI5737 GT ( �c..tl� � ( U%L-j.1L I PCRNtT At � <br /> 7 <br /> ' �494- <br /> O :.BCRATORY NAME C QAeA(,/}U� I COUNTY /.iL/a•rTEJ� PHONE i! �'°ZsJ- O - / !/7�J <br /> SARGL:HG ;IRM .�A � °-5�29EY'A`A11�� !} I PHONE <br /> Illllliitlllllilllllilltllllli <br /> qK l0 # YANK SIZE i CHEMICALS STORED CL'RRE'H7LY/PRE4:OVSLY j DATE UST INSTALLED <br /> 39-%A I32 C( 1 §5 77 14/. OG+O 't <br /> A 9• C7 _— � !� -f i! I i0. L..M.A+� <br /> H 39- ryal egrj,,7 <br /> K 39- v • ,V.• LrN'f�A•u w __) J L /L ! , <br /> 39. •I I <br /> 39- I <br /> IIIIIl lif111111 1 Illtffl I IIlII 1 1 Illtililllilll ! Iiltlllitllltlltlllllilll <br /> P <br /> L PROVED APPROVED WITH coNo[TIDN(57 DI APPROVED <br /> A SEE C 1 (TIONS BELOW ANO/02 ON ATTACHMENT)45 <br /> r i� <br /> Y <br /> PLAN REVIEWER'S NAME OAYE <br /> --- 111111111111111111111itillli111111111111111illllllitllltlillilli1111111t111111i1t1111itIi11ii111111111111111tiltliltttililltl <br /> APPLICANT MUST PERFORM ALL 'ARK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAMS, AND RULES AND REGULATIONS OF <br /> SAN 1:AOUSN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING; "1 CERTIF1 THAT IN <br /> THE PERFOPMANCE OF THF WORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL NOT EMPLOY ANY PERSON IN SUCH A MANNER. AS TO BECOME <br /> SUBJECT TO VCRKEP'G COMPENSATION LAWS OF CALIFORNIA-" CONTRACTOR'S HIRING OR SUBCONTRACTING <br /> OSIGNATURE <br /> RE rCERTIFIESO'HE <br /> FOLLSa INO:II <br /> "1 CERTIFY -,HAT IN THE PER FORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL <br /> I COMPENSATION LAWS Of CALIFORNIA." <br /> APPLICANT'S SIGNATURE! /-1 r n �(�,�L _ TITLE Geti+-/T�/.-��h� DATE <br /> CONDITION(S); / L <br /> i r <br /> 64 0.3 046 (0.ovicad 9/11/90.: Pace 3 <br />