Laserfiche WebLink
APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone ( 209 ) 968_3920— <br /> APPLICATION FOR PIRMINENT/TEMPORIR► CLOSURE OR 1811DONKIII It PL1 8 Of UNDERGIOUMD MIYIRDOUS SUBSTANCES STORAGE FACILITY <br /> 7113 PERMIT RIPIRIS 10 DAYS FROM TNR APPROVAL DITI. DO NOT NR1TE 11 111 SHADED IREIS. INDICITE PERMIT TYPE BELOW: <br /> y REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT PHONE M7 Dy / y( <br /> A ----... <br /> C FACILITY NAME�� �� �y1 ADDRESS�DOS. <br /> L CROSS STREET p PHONE I_0) ./ 33y,cly�2 <br /> I --— <br /> T OWNER PHONE I / <br /> Y 5/A S/4 <br /> C CONTRACTOR NAME/ PHONE M <br /> 0 ---- -- <br /> N CONTRACTOR ADDRESS S� A) � .G�2/N d ti CA LIC I <br /> T <br /> R LIC CLASS /` WORK . COMP. I A INSURER p <br /> A -- --�— -- -- ------ _—.— — -- —_ <br /> C FIRE DISTRICT �' , p, ( PERMIT I <br /> T — <br /> 0 LABORATORY NAME fR PHONE I �/ <br /> R -- -- -- <br /> SAMPLERS NAME SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID I CURRENTLY PREVIOUSLY <br /> M �TO AAZ �✓/s4 '------ <br /> I TO <br /> C TO <br /> A TO <br /> L LIS ANY EXTRA TANKS ON A SEPERATE SH ET <br /> P EmiMPIME Immm wimmimill <br /> L (SEE AT JI HMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME _ n tr�� DATE <br /> N <br /> APPLICANT MUSE PRIFOIM ILL 101E IM /CCORDIYCI FIN SAN JOIQUIM COUNTY OIDININCIS, Sf1fE LIVS, IND RULES AMD REGULATIONS <br /> OF fig SAN JOAQUIN LOCAL IIILfM DISTRICT. 01NE1 OR LICENSED IGEly's SIGNATURE CERTIFIES THE FOLLOVING: 'I C111111 THAT <br /> IN fit FEIFORMINCE OF fYE IORI FOR 11ICN THIS PERMIT IS ISSUED, I SMALL NOT EMPLOY ANI PERSON IN SUCH M1NNE1 AS TO BECOME <br /> SURJECf TO 109IMIN'S CONPINS1TIO1 LII$ OF CILIF0E111.' COETRICTOR'S MINING OR SIII-CONTRICTINC SIGNATURE CEEfIFIES THE <br /> FOLLOIING: 'I CERTIFY f1Af IN TMI PEIFORMIHCI OF fig FOIN FOR IIICI THIS PERMIT IS ISSUED, I SHILL EMPLOY PERSONS SUBJECT <br /> TO IORIMIN'S COMPEISIT101 LIN$ OF CALIFORNIA. COMPLETE DRIVING ON ATTACHED PLOT PLAN Silly. <br /> CALL FOR ALL NECESSARY INSPECTIONSATLEAST 98 HOURS IN ADVANCE/ <br /> SIGNED X � TITLE: DATE: <br /> ACCEPTED BY TITLE: DATE: <br /> " I :' 0.�4iMJIC 08i"3hOUI1EDRu"eURUYLBMtliNUYflIt11UEINRYE11�Irr:.•.ra ,,y�w,,,,..,�+S,191,,L,,CAL '9I:W Y`", 'g 'r,a ►�w�w- -- <br /> BDA' PER � <br />