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ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> TANK <br /> APPLICATION <br /> OHANTPO1tARY THEAPPROVALADATE. Do NOT WRITE OFUNDERGROUND <br /> ANY SHADEDDAREAS. I NDICATET PERMIT T TTYPEE BELOW: <br /> ITEXPIRES 90DAYSf <br /> CLOSURE IN PLACE <br /> X REMOVAL _ TEMPORARY CLOSURE <br /> PROJECT CONTACT 6 TELEPHONE I (209)983-0233 Lonnie Hanson <br /> EPA SITE 0 CAC 000830288 PHONE 0 (800)742-2022 <br /> F FACILITY NAME Commercial Transfer Inc. <br /> A <br /> C ADDRESS 16 1 Louise Ave. Lathro Ca. 95330 <br /> I <br /> L CROSS STREET )? 5t' PHONE A <br /> 1 <br /> T OWNER/OPERATOR <br /> Y Same as above PHONE # 20 368-61 <br /> C CONTRACTOR NAME Jim Thorpe Oil. Inc./Rich-Mart Construction CLASS 0 CA uc x 4 56 A B Haz. <br /> N CONTRACTOR ADDRESS 351 N. Beckman Rd Lodi Ca. 95240 VORK.COMP-M O _ <br /> T <br /> R INSURER F1reTOans Fund/ New ECl land PERMIT Of To be arran ed <br /> A <br /> C FIRE DISTRICT PHONE k 20 2-Q OO <br /> T <br /> 0 LABORATORY NAME GeoAnal tical Laboratories T PHONE N 20 _ <br /> R <br /> SAMPLING FIRM Same aabove <br /> 11111111���������������������� TANK 812E CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE USE UQ T <br /> TANK ID R -- <br /> 39- <br /> T 39- <br /> A 39- <br /> H 39- <br /> K 39- IIIIIIIII�IIFF���"" <br /> 39- 11111�� <br /> 39- <br /> 1111 DISAPPROVED <br /> P X APPROVED APPROVED WITH CONDITION(S) __ <br /> L -- (SEE AT CHME N TH CONDITIONS) DATE 4-? G /L <br /> A <br /> N PLAN REVIEWERS NAME <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAOUIH COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> CERTIFIESATURE THE FOLLOWING- <br /> CERTIFY <br /> T IN <br /> IN ENPUBLIC HEALTH <br /> SERVICES. <br /> MYDASG <br /> SAN JOAQUDISHALLNOTEMPLY ANY PERSON IN SUCH A MANNERAS TO BECOME <br /> WHICH PE S SICERTIFIES FOLLOWING: <br /> TNN PERFORMANCE THEVORKFORLLC <br /> SUBJCYWORKER'SCOMNSATOLAWSOFCAORNIA. CONT RORC <br /> CERTIFY THEE or WORKFOR IS ISSUED, ISNAEMPLOYPERSONS SUBJECT 10 WORKER� <br /> 111 <br /> COMPENSATION LAWS OF CALIFORNI ./� 12/3/92 <br /> TITLE Contractor DATE <br /> APPLICANT'S SIGNATURE: <br /> Page 3 <br /> EH 23 046 (Revised 7/10/92) <br />