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p APPLICAVON- FOR -PERMIT - .p--SAN-JOAQUIN-LOCAL HEALTH- "TR1CT-p <br />p UNDE UND TANK p 1601 E HAZELTON AVE., STC <br />�,,/ d CA p <br />p CLOSURP9k ABANDONMENT p Telephone (20'D 463 -'''TO p <br />MMMMMMMM MMMM a M!.Wt MMM a!: I! Mptii!:Mk'MM!fl1a!iMpa MM1:MMMMalifigh50ppM!:Mplilit M <br />APPLICATION FOR PERMANENT/ TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br />THIS PERMIT EXPIRES 30 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br />x REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br />EPA SITE 1 <br />PROJECT CONTACT 6 TELEPHONE I <br />F <br />FACILITY NAME HEINZ PLANT — J <br />PHONE Y <br />(209) 832-4241 <br />A <br />C <br />1 <br />ADDRESS 757 E. 11TH STREET, TRACY, CA 95376 <br />L <br />1 <br />CROSS STREET Mac Archer <br />T <br />OWNER/OPERATOR, BJJ Trucking <br />PHONE I <br />Y <br />2431 Mariposa Road <br />(209) 941-8361 <br />Stockton CA 95205 <br />C <br />O <br />CONTRACTOR NAME <br />Precision Industries, Inc. <br />PHONE tl <br />(209) 462-9911 <br />N <br />T <br />CONTRACTOR ADDRESS 1041 S. Pershing Avenue <br />�A LIC 1 467293 <br />CLASS <br />A <br />T.' <br />A <br />INSURER Ohio Casualt Grou <br />— — <br />WORK.COMP.i <br />89) 400-97-87 <br />_ <br />C <br />FIRE DISTRICT Tracy <br />PERMIT 1/INSPTR <br />0 <br />LABORATORY NAME Canonie Labs <br />PHONE 1 <br />(209) 983-1340 <br />R <br />SAMPLING FIRM* SAMPLING METHOD <br />TANK ID 1 TANK SIIE (CHEMICALS STORED CURRENTLY CHEMICALS STOPED PREVIOUSLY <br />12,000 gallon diesel fuel N/A <br />AT) ----- - <br />-0/ <br />----------------------------- <br />'3— <br />K 19----------------------------- <br />---------------------------- <br />33 ---------------------------- <br />LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br />Rmlf <br />P -___ APPROVED APPROVED WITH CONDITIONS DISAPPROVED <br />L (SEE ATTACHMENT WITH CONDITIONS) cc <br />A PLAN REVIEWERS NAME ------_--_--iQ�/yJ-- 1-s¢✓/Lg----------------DATE _O_5 <br />N -----_--�-/U <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br />OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT <br />IN THE PERFORMANCE OF THE WORT; FOR WHICH THIS PERMIT 15 ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNED. AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br />FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT <br />10 WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br />CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br />SIGNED----------------------------------------------------------------------------------DATE <br />- <br />OFFICE USE ONLY <br />fSfifSfiffffffSitffffffitffifffSSSffSftfitifSifffffiffSfSSffifffffffff{fffffiSiffifffffffffffffffffffffffiffffffffffffifff <br />SWEEPS 1 COMP I 'LOC CODE '01ST CODE' AMOUNT DUE AMOUNT kCVO CIA/CASH RCVO BY DATE RCVD PERMIT <br />l901(o BjA151 63 1 L/al - L -- --- --- <br />