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1418 R 91tttt' rtetttttutrtrtrtttttetatttttititiRiRtttetr' <tt 'i.�i•�y("1 <br />e APPLICATIP' t PERMIT t: SAN JOAQUIN LOCAL HEALTH DIF I t: <br />t: CLOSURE <br />OR AB TANK t; 1601 E Telephone <br />AVE., STOCKT60-342TMrCA 4 paxaWto <br />CLOSUkE OR ABANDONMENT t: Telephone 12091 468-3420 t, <br />ff"ff.. :: <br />FEB 11989 <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE, DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERTIiT_TYMJ9W_ AL k'ALTH <br />PER%ilT I SERVICES <br />REMOVAL _____ TEMPORARY CLOSURE __-- ABANDONMENT IN PLACE <br />235 <br />EPA SITE 1 CAC 000 146789 <br />PROJECT CONTACT 1 TELEPHONE Frank Preiss (209) 333- <br />E <br />FACILITY NAME Color Spot <br />-1 <br />PHONE t (209) 333-0235 <br />A <br />C <br />I <br />ADDRESS <br />5400 E. Harney, Lodi, CA 95240 <br />L <br />1 <br />CROSS STREET <br />Hwy 99 <br />T <br />OWNER/OPERATORMike Vukelich, Sr. <br />PHONE 1 (415) 237-8066 <br />Y <br />C <br />CONTRACTOR NAME Jim Thorpe Oil, Inc. <br />PHONE 1 (209) 462-4581 <br />0 <br />N <br />CONTRACTOR ADDRESS 351 N, Beckman Road, Lodi , CA <br />CA LIC 1 495699 <br />CLASS A, Haz. <br />T <br />R <br />INSURER on f i l eWORK.COMP.1 <br />on file <br />C <br />FIRE DISTRICT Mokel umne 944-2414 <br />PERMIT i/INSPTR <br />T <br />0 <br />LABORATORY NAME Canonie Environmental <br />_ <br />PHONE 1 (209) 983-1340 <br />R <br />SAMPLING FIRM* C �c ✓l c yt r L <br />��zz <br />SAMPLING METHOD 1] ra SS%-� <br />TANK 1D i TANK SIZE CHEMICALS STORED CURRENTL CHEMICALLel <br />T <br />A <br />39 Z3 �� :oj 4,000 gal. Diesel Di <br />N <br />39- <br />K <br />---------------------------- <br />39- <br />39 <br />39 — <br />LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br />P <br />APPROVED APPROVED WITH CONDITIONS DISAPPROVED <br />L <br />A <br />___ <br />(SEE ATTACHMENT WITH CONDITIONS) % <br />PLAN REVIEWERS NAME [ DATE_F_2�� <br />N <br />----------------------- <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 SHWURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT <br />IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <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 SUBJEC <br />NSAiION LAWS OF CALIFORNIA. <br />S AT LEAST 48 HOURS IN ADVANCE <br />±WORKERISCOMOM <br />_ _ qq-President 2/1/89 <br />-- --- L!s%- V----------------------------------------DATE- <br />LY--EN 13 018 88ssssssssssssss <br />ssssssssssss� <br />1 LOC CODE DIST CODE AMOUNT DUE CK//CASH RCVD BY I DATE RCVD I PERMIT 1 I <br />235 <br />