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FAPPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone ( 209 ) 468-3420 <br /> VF <br /> ►PPLICITION 101 PI1Il11IT/TgWO111T CLOSURE OR 1911DOINIET 11 PUCE Of UIDSRGROUID IIILIDOUS S STOIIG6 I I�n) <br /> TINS PRINT 1IP11SS TI oils Flom TIE 1PPROTIL D1T1. DO NOT IIITs 11 111 511D11 IREIS. INDICT PE1M�T,T 0�1:� VV <br /> XX REMOVAL XX TEMPORARY CLOSURE ABANDONME <br /> C�C tbt4� I(p� ENVIRON <br /> F PROJECT CONTACT GARY WEBER PHONE # 209 / 466-6 3ERV7CES <br /> A <br /> C FACILITY NAME Down River Forest ADDRESS 6800 Fairchild Road Stkn. Ca. <br /> I <br /> L CROSS STREET Navone Rd. PHONE # 209 / 466-6726 <br /> I <br /> T OWNER PHONE # 2�/ 466-6726 <br /> Y DOWN RIVER FOREST PRODUCTS 1221 N. Golden Gate Ave. Stkn. Ca. <br /> C CONTRACTOR NAME Stockton Contracting PHONE # 209/ 462-5082 <br /> O Group, Inc. <br /> N CONTRACTOR ADDRESS 1000 N. Union St. Stkn. Ca. 95205 1 CA LIC # 528156 <br /> T <br /> R LIC CLASS A WORK . COMP . I On File INSURER On File <br /> A <br /> C FIRE DISTRICT STOCKTON PERMIT # <br /> T <br /> 0 LABORATORY NAME Canonie Engineering PHONE # 209/ 983-1340 <br /> R <br /> SAMPLERS NAME O MPLING METHOD HAND <br /> C VOLUME CHEMICALS ST RED DATES STORED CHEMICALS STORED <br /> H D� # Zat90 RREEN-`TLG PREVI USSLY <br /> E eI1 <br /> M 2 ZaBn t CS C�- 4 K: L TO A-)apt- <br /> I —TO— <br /> C TO <br /> ATO <br /> L LIS ANY EXTRA TANKS 01 SEPERATE SH ET <br /> P i <br /> L (SEE AFT M NT CONDITIONS) <br /> A PLAN REVIEWERS NAME P DAT <br /> N `. <br /> /PPLICIIf NOSE PERPOSN ILL lost 11 ICCORDINCE It TE SIR JOIOUII COVITT Ot0Il1ICts, stiff LITS, UD RULES IND REGULNIONS <br /> OP TRE Sit JOIQUII LOCIL IEILTI DISTRICT. Olin of LICIISED 1E1IT'S SIEIITURE CERTIFIES In POLLDIINC: 11 CIRIIF1 TINT <br /> II fit PERFOIN/ICI OP TNS ROSE FOR 11IC► fill PERNIT IS ISSUED, I SI1LI /Of Sam III PERSON I► SUCI multi IS TO 11CONE <br /> SUEJECf TO 1011111'! CONPIIS1TIO1 LITS OF CILIFO1111.' COITIIClOR'S IIRIIG Of 111-COIRIICTIIG Summit CE mus TRS <br /> FOLIOUIG: 'I CIIfIFT T/lf If TIS PERFORNIICS Of fll FOIE FOR IIICI fill PIINIf IS ISSUED, I S/ILL IIPLOT PIRSOIS SUBJECT <br /> TO ►ORININ'S CONPIISITIO/ LIFS OF CILIFOR/Il, COIPLITI DRIIIIG ON 011CRED PLOT PLII SIE1f. <br /> CALL FOR ALL NECESSARY INSPECTIONS ,A LEAST 48 HOURS IN ADVANCE <br /> SIG I£ TITLE L/�/f DATE: o /�p <br /> — <br /> ACCEPTED BY TITLE: DATE: <br /> 8�.� I �ZD I I I �� <br />