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tIVki:tt'tykyti'tt'kY tt'tttr tt'n.IT,ve n.n.It n t1111111 tl tCtt'tt'niti'tYtt'tY y <br /> APPLICITIO" I PERMIT t $11 JOAQUIN LOCAL KERLIN 019" 'Ti: <br /> r UIDBRGR01k TANI t: 1101 E HAlEL10A Ave., 91OCKTVe4 t <br /> t: CLOSURE OR Il6NDOMMEIT t Telephone (2091 468-1421 r <br /> tkl:1141 It tyk1:tYk1:k ktt.tt tt tY tt tt It lilt tt tt t;t;t;ti ltNk;l;ti tY tt'tt ... <br /> IPPLICITIOK FOR PIRMANKIT/TEMPORARY CLOSUTA OR ABANDONMENT 11 PLACE OR UNDERGROUND 1111RDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT MITE IN 111 S11011 AREAS. INDICATE PERMIT TIPS IRLOW: <br /> REMOVAL TEMPORARY CLOSURE — ABANDONMENT IN PLACE <br /> Don Plaso-1 J <br /> EPI Site 1 �C�p(fa�E/663 PROJECT CONTACT i TELEPHONE I %,.209 )836- 1640 <br /> F FACILITY NINE City Of Tracy Firestation #2 PHONE 1 "209 )835-9718 <br /> 1 <br /> C ADDRESS 301 E. Grantline Rd . Trsc, CA 95376 <br /> 1 <br /> L CROSS STRIt? Parker Ave . <br /> I <br /> I OVNER/OPRRITOR 0�ty of Tracy_ P80111 .1 (209 )836-2670 <br /> T <br /> C COITIICTOR PIMA PRONE I Vit,y_ a q <br /> 0 <br /> COITRICTOR ADDRESS 9 3/ r/ � MOC 7n CI LIC 144gp&4 CLI13 d_ <br /> T <br /> 0 IPSURRIl 4eler _n!S IOIK.COMP.1 88056-6p <br /> 1 <br /> ImAr <br /> C /IRE DISTRICT C N PERMIT 1/IISPTR <br /> T <br /> 0 LABORATORY IAMB ,rE PHONE 1 Sa7_ A p 'SO <br /> A <br /> 9AMPLIIGPIRMt 3WdHE SIMPLIIGMBT1000tE`�i"- TE1PHLas6V- Z�s 40 <br /> 1RlIOMMINOBNNNINEMMMNEIID118BN A?'S-t E - 9�-:ZU <br /> TINE ID I Till site CHIMICILS STORED CURREITLI CHEMICALS STORED PRBVIOUSL <br /> T 1000 Di° "' <br /> - <br /> ue'. Diesel .7uel <br /> 1 J9- <br /> J9- - <br /> -- — LIST 1801110NIL FINK INFORMATION IS BBEDED OI SEPARATE PORK <br /> VN1111IRIHItlDPItlNVIIIIRWNIVIIdVKIWtlOYNNVWMIIgBIVWVYIAtl. BtlIBVIIgtItlMIVIIIVDIkJDkSNVtlR9i!NUf.11lDIVMI�tlV9DllIMiRWllilll@IV9tl9D11'�ItlDiR49iVtBBI0tltlM2Y!IItlIMBBtl61lIJNIDIRIMtlIBIVNWtlN16NIVILbCAIVIBIYVIIIVIKIItlIWRI:'I' <br /> i,lp <br /> APPROVED APPROVED WITH CONDITIONS DIJIPPROVIDTIOIS) <br /> LA181111¢13 NINE <br /> IRI%NYi®npI0011A1NNAKBaIIKR07tlWIRNWIgR1 0Wt1�V1111Rm <br /> IPPLICANT MUST PERFORM ILL WORK IN ACCORDANCE Will SIN JOIOUIN COUITY ORDINANCES, STATE LAWS, AND RULES IND REGULATIONS <br /> OF TNS SIN JOAOUIN LOCAL BRAIN DISTRICT. DINER OR LICEISBD IG11t'3 SICIITURA CERTIFIES THB FOLLOWING: 91 CERTIFY THAT <br /> IN THA PEIFORMAMCR OF THE HONK FOR VNICH THIS PERMIT IS ISSUED, I SHALL 10T EHPLOT ANY PRISON IN SUCH MANNER IS TO BECOM <br /> SUBJECT TO WORKER'S COMPENSATION LITS OF CALIFORNIA.' CONTRICTO113 HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 01 CERTIFY THAT IN THE PERFORMANCE Of TIIB IOIK FOR WHICH THIS PRRMIT 13 ISSUED, 1 SHILL EMPLOY PERSONS SUBJRC <br /> TO VORKAR'S COMPENSATION LIIS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 40 HOURS IN ADVANCE <br /> OFFICE USP OMIT•-EH 71 016 12111 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS499SSSS9SSSSSSISSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSf9SSSS9S11SS5 <br /> SIBIPS-1 I COMP I LOC CODE�DISI CODEI AMOUNT DUET AMOUNT RCVD I CKI/CISB I RCVD li I Dill RCVD PERMIT 1 <br />