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V It It:It Its It tarty It it lit It It It It It It a IY It It It it It it It It It It it: It it it: <br />r APPLICITIOM FOR PERMIT I: SAM JOIOUII LOCAL HEILTR DISTRICT <br />UNDERGROUND TANI V 1601 1 HAIELTON AVB., StOCKTON CIV <br />W: CLOSURE OR 11111DONMENT I. Telephone (2091 468-14I0 V <br />t tt It IS' it It It Ct It' it: Iit it it it: it. It it: It tt It it: It It It it: R: it: IV it: It IY IY it: <br />IPPLIC01011 FOR PERMANENT/TBMPORIRT CLOSURE OR ARAIDONMENT IN PLACE OF UNDERGROUND HAIIIOOUS SUBSTINCES STORAGE FACILITY <br />IBIS PERMIT EIPIRIS 90 DAYS FROM THE IPPROVIL D1TE. DO NOT WRITE IN 111 SHADED AREAS. INDICATE PERMIT TYPE 111,011: <br />REMOVAL TEMPORARY CLOSURE — ABIYDONMENT IN PLICI <br />IPI $III I GaL O©O S: -I /2. O <br />PROJECT CONTICT I TELEPHONE I ,JIM HOBLITZELL 463 7108 <br />F FACILITT 111E GOTELLI FORKLIFT, INC. <br />PHONE 1 (209) 465 3609 <br />C IDDRISS 1856 N. BROADWAY, STOCKTON, CALIFORNIA 95205 <br />1 <br />L CROSS STNNIT WATERLOO ROAD <br />T OYMII/OPIRITOR <br />T It -ED GOTELLI <br />PHONE <br />(209) 465 3609 <br />------------- <br />C CO'TRICTOR I'M' FALCON ENERGY ASSOCIATES <br />PHONE 1 (209) 463 7108 — <br />0 <br />1 COMTRICTOR 1001s3M. Box 125/ <br />cl Llc 1584524 <br />cL►ss A <br />I <br />— <br />R IISu¢IR ON FILE <br />Vol[ -COMP -1 ON FILE <br />C FIRE DISTRICTCITY OF STOCKTON <br />PERMIT I/tlsat¢ <br />T — <br />O L180¢ITOR1 "X'SEQUOIA ANALYTICAL, REDWOOD CITY <br />PHONE 1 (209) 838 3507 <br />R - <br />SIMPLINGM FIRM' Sim SCALON sanPLIMC NHr'BD SEE 'ATTACHED---- <br />— DDI <br />TIME ID I ?III Site CHEMICILS STORED CURRENILI CHEMICILS STORED PRI910USL <br />T <br />]f- /�Z� % 12,000 DIESEL DIESEL <br />1 ' of <br />Y 19-27 - p2-- -pickiii <br />I ]9- <br />j-- LIST ADDITIONAL TANK IMFORHIIIOM AS NEEDED 01 SEPARITE FORK <br />WYWWMIW'MYIYYYUMWIYWWYItlIYYWYMHIWNIpWYIIIYIWIH111NNIYWHIIIIIIIIHIIJYNC7NYIIIIIW!WI311WHItlIN'UYYWgtlIR!YINLNdIININIUYY8J11iHWIliW!91iNRNIIINI!Y!WN:NWHLIN7MIWIYNWGWYDWW4gIL'WYNIHIWGYIWWHII <br />P -- IPPROVED IPPROYIO WITH CONDITIONS DISAPPROVED <br />L (SIB ITTACHNENT WITH CONDITIONS) <br />1 PLIN RIVIEWERS RIMA jF�Yy`7&VfW4 ------------_D►1H--`t �Y� <br />------- <br />N <br />— WWR1MNtlWWMWNMMIAW11R1WY�YKNWKWMItlIY41YW1NN�WKNYWWWOYNMNNIWMINNYWWIIIRIWKWWIYNNKYRNiMWWNNINWWWIUWIRWIWNBWWIYRWRNYIRYIWWIYW <br />IPPLICANT MUST PERFORM ALL YORK 11 ACCORDINCE WITH SIM JOl0UIH COUITT ORDIMINCES, STITE L/WS, AND RULES IND REGULATIONS <br />OF TOR SIM JOAQUIN LOCAL HEALTH DISTRICT, OWNER OR LICENSED AGENT'S SIGMITURE CERTIFIES THE FOLLOWING: 11 CERTIFY THAT <br />IN IHS PERFORMANCE OF THE YORK FOR YHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IM SUCH MANNER AS TO BECOM <br />SUBJECT TO YORKER'S COMPENSITION LAYS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br />FOLLOWING: 11 CERTIFY THIT IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br />TO YORKER'S COMPENSITIOR LIWS OF CILIFORYII. <br />CALL FORINSPECTIONS AT EAST 40 HOURS IN ADVANCE <br />SIGNED_�`�— -- -- DATE <br />— <br />OFFICE USE ONLY -N11 21 <br />SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS9SS SSSSSSSSSSSSSSSSSSSSSSSSS$SSSSSSSSSSSSSSSSSSSSSSSSSSiff$SSSSSSSSSSS <br />SWEEPS —II COMP ILOC CODE (DIST COD BI IMOOMT DUII AMOUNT RC VD I CKI/C ASR RC PD BY 1 0179 ¢CVD I PERMIT I <br />