Laserfiche WebLink
PAYMENT nc-1 <br /> RECEIVED <br /> ENVIRCHMENTAL HEALTH DIVISION AUG 12 1992 <br /> APPLICATION FOR UNDERCRCLND TANK CLOSURE PERMIT SAN JOAQUIN COUNTY <br /> P. T Ti-4 <br /> APPLICATION FOR PERMANENT/TENPCRARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDCLS SUBSTANCE STCRAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM TH PPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> Soil Assessment to <br /> REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE X Evaluate .Potential <br /> Closure 0 .tions <br /> EPA SITE N CAC 000250193 PROJECT CONTACT & TELEPHONE X Rex Gr Ori (209)468-3357 <br /> F FACILITY NAME PHONE X <br /> A Stockton Courthouse Annex (209)468-3357 <br /> c ADDRESS 24 So. Hunter Street , Stockton, California <br /> I <br /> L CRCSS STREET San Joaquin Street <br /> I <br /> T CANER/OPERATOR San Joaquin Court PHONE 0 Manfred Sanders <br /> Y Purchasing Division (209)468-3252 <br /> C CCNTRACTCR NAME Spectrum Exploration bk' PHONE 9 Jim Kleinfelder <br /> 0 948-1345 <br /> N CONTRACTOR ADDRESS 2825 East Myrtle Street CA LIC a cuss oIL <br /> T Stockton, CA 95205 512268 C-57 <br /> R INSURER Pacific Compensation WORK.CCMP.x WPO12483 <br /> A <br /> C FIRE DISTRICT O <br /> Tank cutting or removing tanks PERMIT 0 <br /> T is empty <br /> NIA <br /> c, <br /> D LABORATORY NAME A ricultural and PriorityPollutants PHONE x <br /> R (209)275-4422 <br /> ndlay <br /> SAMPLING FIRM Kleinfelder PHONE 1, 66-17 <br /> IIIllllllllllllllillllllllllll 916 366-1701 <br /> TANK ID 3 TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> 39- 2372-01 20 , 000 gallon Diesel-Underground 1980' s <br /> T 39- <br /> A 39- <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> P 111111111111111111111111111111111 llllllillllllllll111111111111111111111111111111111111111111111 Illllllfllllilllillli <br /> L APPROVED APPROVED WITH CCNDITICN(S) DISAPPROVED <br /> A (SEE ATTASWART WITH CONDITIONS) <br /> N PLAN REVIEWERS NAME ir��t0-l/3� DATE <br /> lllllllllllllllllllllilllllll111111111111111 11111111111111111111111111111lillllillllllliililllllll11111111111111111111111 <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JCACUIx COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "1 CERTIFY THAT IN <br /> THE PERFORMANCE OF THE 'ARK FOR WHICH THIS PERMIT IS ISSUED, I SMALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAK OF CALIFORNIA." CONTRACTORIS HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> CCMPENSATICN LAWS OF CALIFORNIA.- "� <br /> APPLICANT'S SIGNATURE: TITLE{K_' Pr rr,Lv.�.� ( ATE 7 ��& <br /> A 23 046 (Rev 2/8/91) ft Page 3 - <br />