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ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> XX REMOVAL TEMPORARY CLOSURE _ CLOSURE IN PLACE 93 ra-pV57-7671 <br /> EPA SITE #CACOOO92O6O8 I PROJECT CONTACT d TELEPHONE #Army Corp.Eng. Larry Bergmooser <br /> F FACILITY NAME Stockton Metropolitan Airport PHONE # Federal Aviation Admin s. <br /> A <br /> C ADDRESS Airport Way, Stockton, CA. Ph#209-946-6310 <br /> I <br /> L CROSS STREET <br /> I <br /> T OWNER/OPERATOR PHONE # <br /> Y Owner of tank: Federal Aviation Administration 209-946-6310 <br /> C CONTRACTOR NAMEPHONE # <br /> N CONTRACTOR ADDRESS 1820 Bidwell St., RFA B1uff,CA CA LIC # 291772 CLASS B w/C61/1)4O <br /> T <br /> 5 q� INSURER State Compensation Insurance Fund wRK•c°MP-# 536-000016-93 <br /> f0.y1 FIRE DISTRICT MOntaZUma Fire District PERMIt <br /> Y <br /> I-fABORATORY NAMjfflR3Tj ttn: Kevin McNeill PHONE # 303-969-8778 <br /> 1 SAMPLING FIRM eWOOd, Colorado, Attn: Kevin McNeill PHONE # 303-969-8778 <br /> nnnnnnNK ID# nn <br /> TANK ID # TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY GATE UST INSTALLED <br /> 39- iinknnyn 1nnn gal njan pi nnknn <br /> T 39- <br /> A 39- <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> P <br /> L APPROVED APPROVED WITH CONDITION(S) DISAPPROVED <br /> A ( TAC EIH WITH GOND TTI S) DAZE <br /> N PLAN REVIEWERS NAME <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S 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 /> COMPENSATION LAWS OF CALIFORNIA." <br /> 'POM MEHRINGER CONSTRWTIOR, INC. <br /> APPLICANT'S SIGNATURE: By: �tr-s+-t �'/'/O��' a✓ TITLE P a./Chun r DATE 4/1/94 <br /> V3 Hud a r 1 . Se-c p444-0 . <br /> 2- - ccs <br /> sic.. Pn-;.a. / AAn�' I Sa�yp�o�G'•6 cl.i..oP Ow.a.l y S <br /> �.. GTe tq,l/A.1/+TAti. rn•,w,e� )X... /hI.J 7 I' ,,' -�l ee.Q /L. s //D�•a-�" N.v- ��M <br /> EH 23 046 (Revised 7/10/92) SAn_&#7j�_ 7'S 14#WWK Jae 3 Vt,,C.N1V�.YvtJ� pC <br />