Laserfiche WebLink
F <br />A <br />C <br />I <br />L <br />I <br />T <br />Y <br />C <br />0 <br />N <br />T <br />R <br />A <br />C <br />T <br />0 <br />R <br />H <br />E <br />M <br />C <br />A <br />L <br />UNDERGROUND TANK 0 1601 E HAZELTON AV., STOCKTON CA <br />CLOSURE OR ABANDONMENT Telephone (209) 4683420 <br />11PLIC1TI01 rot P111"llf/Tapol1tI CLOSURL OR 1111DOIXIIT IL PWCL OF UIDBRCROUND linuOUS SUIST1ICEs STORAGE F1CILITI <br />T1IS PRIX LIPIRRS TI D;IIS 1104 Tit 1PPROIIL Dirt. DO 101 TRITI 11 111 SIIDID HEIS, 11DICITI PERMIT TIPS RILOY: <br />REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br />PROJECT CONTACT <br />FACILITY NAME <br />CROSS STREET/ <br />OWNER I)e, / -/-/) <br />/b PHONE # ::;))4 <br />4cl,lito ADDRESS <br />(71 PHONE #,J <br />7'/'GC ck -.Tq /SGS PHONE # �/ <br />P` -51y61 <br />CONTRACTOR NAME �� roe PHONE 1 <br />CONTRACTOR ADDRESS y]' ► CA L I C 9 <G <br />LIC CLASS WORK. COMP. #1451,35-�8� INSURER <br />FIRE DISTRICT PERMIT PERMIT Y r <br />LABORATORY NAME PHONE t �'—CJt / �fi 3- <br />SAMPLERS NAME SAMPLING METHOD <br />VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br />,SID I CURRENTLY PREVIOUSLY <br />WON 0 <br />► i <br />w1owN .� <br />LIST ANY EXTRA TANKS 0 <br />TO <br />TO <br />TO <br />TO <br />A SEPERATE SH1 <br />T <br />x„r•. r,;.r a CI! �ngoPl tlrrf!ryrynritirnpxi�ryp! �r+*rw ari pl I <br />a I <br />Nl <br />• aN • t r • • f .r . IM.aai• • !a rl' 'I d!; <br />-I-TIOA LL <br />TTAQHPfENT W1• <br />F.'PLAN•(SEEDATE <br />ih <br />IPPLICIII LUST PERFORM ILL FORK 11 ICCRDINCI rITH sir J010UIN CoU1rI 010IN11cts, Sun L1FS, 110 RULES alto REGULITIONS <br />OF THE 311 J010UIN LOCAL 111179 DISTRICT. CHER OR LICENSED 1G117'3 SIGIITORE CEIrIFIES THE FOLLOU IG: 'I C22T1FT THAT <br />IN 19: PERFORXINCI OF fig FORK FOR FRICH TIIS PERNIf Is ISSUED, I S11LL Nor smor 1Nr PERSON a SUCH NINNER is to NECONE <br />SUBJECT 10 FORIN1111 CONPIISITION ills OF CILIFORXII.' COITRICMOR'S 1111NG OR J91-CONTRICTING SIGIITURE C%RTIFIBS THS <br />FOLLOFfIG: 'I CERfIrI flit I1 THS PBRFORIIIICR OF Tgf PORK FOR F1IC1 f1IS PERXff IS ISSUED, I SHILL EMPLOY PIRS013 SUNICT <br />TO FORININ'S CONPE1SIT101 LIFE Ol CILIF02111, COMPLETE DRIFING 01 1ffICKED PLOT PLAN SHEET. <br />CALL FOR ALL NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br />SIGNED X <br />TITLE: <br />DATE: <br />A -L-1 <br />