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t tt rt tt tt ti:tl:ti tit R LI: t1: rt: t1:tt:ti: tfitl ti: fftt'tl:tt:tt tl:tt t,. �tl'tl tt <br />i r APPLIC1110N FOR PERMIT ,: SIN JOIOUIN LOCAL HEALTH DISTRICT,: <br />t <br />UNDERGROUND TANK t: 1601 E HAIELTON AVB., STOCKTON CIt: <br />t: CLOSURE OR 1BINDOYMENT t: telephone (209) 168-1120 <br />t: <br />t tt <br />ti: R ti ti: ti: ti: ti: ti: tit: ff ti: tt:R:ti: ti: ti: R: ft, R:tt:R:R:ft: R:R:R:ti: tr. ti: ti: ti: <br />IPPLICITION FOR PRRMANENT/TEMPORIRT CLOSURE OR ABANDONMENT IM PLACE Of UNDERGROUND BIi1RDOUS SUBSTINCES STORIGE FACILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN 111 SIIADBI AREAS. INDICATE PERMIT TYPE BRLOW: <br />X RBMOVIL __- TEMPORARY CLOSURE — IBINDOMMRNT IM PLACE <br />EPI SITE <br />P FACILITY NINE Breunerg <br />I <br />C ADDRESS <br />I 7676 Pacific Ave. <br />L CROSS StRRBT Hammer Lane <br />1 OVNER/OPERATOR <br />Y <br />PROJECT CONTACT I TELEPHONE I Gary Trumpp <br />408-292-0aZQ <br />—_HONE <br />209-47A_szi q i <br />Stockton <br />PHONE I <br />Breuner's 41.5-866-_4300 <br />CCortRICTOR NINE Trumpp Bros. , Inc -General Engineer. PHONE 1� <br />Dr,...... a- nnn nnn ,nn, <br />I I CONTRICTOR IDDRBSS cl Ltc t <br />1540 Industrial 324079 <br />R [rSURRRContinental CAS (CNA -S.. ) YORK.COMP.t_ 70_4717641 <br />I ----- <br />C PIRG DISTRICT _ PERMIT I/[NSP1R� <br />T Stockton Fire Dept. <br />o LABoeltolr WINS <br />Brown & Caldwell PHONE I 415-428-2300 <br />R <br />SIMPLING FIRM, <br />TANI ID I <br />1 <br />N <br />C ]9- <br />19 <br />P <br />L <br />IJILIN RRV[EYERS NAME <br />Y <br />Eric ke SAMPLING MEf10D <br />CLASS A <br />Exp. 7-1-90 <br />TANK SI1E (CHEMICALS STORED CURRENTL CHEMICALS STORED PRIROUSL <br />10,000 <br />1----D.ase 1 _ Diesel <br />LIST ADDITIONAL TINK INFORMATION IS NEEDED ON SEPARITR PORK <br />-Ill ....................... _ - - <br />APPROVED _1PPROVRD WITH CONDITIONS _ DISAPPROVED <br />E6 ATTACHMENT WITH CONDITIONS) <br />APPLICINt MUST PERFORM ALL YORK 11 ICC09DINCE WITH SIN JOIOUIM COUNTY ORDINANCES, STATE LIPS, IND RULES IND REGULITIONS <br />OF THE SIN JOAOUIN LOCAL HEILTH DISTRICT. OWNER OR LICENSED !GENT'S SIGNITURS CERTIFIES TNS FOLLOWING: 'I CERTIFY THAT <br />IN THE PERFORHAMCR OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH HINNER IS TO BECOMI <br />SUBJECT TO YORKER'S COMPENSATION LIPS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING 31GUITURB CERTIFIES THE <br />FOLLOWING: 'I CERTIFY THIT IN THE PERFORMANCE OF THE Vol' FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJBC' <br />TO YORKER'S COMPENSITION LIPS OF CALIFORNII. <br />CALL,)FOR INSQECTIONS AT LEAST 48 HOURS IN ADVANCE <br />SIGNED t <br />DItR�� <br />OPPICR USE ONLY-- ?) Olf I?/ <br />SSSSSSSSSSSSsiss SSSSSSssssssSssSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS�SSSSSS <br />SVBEPS I COMP I I,OC CODE DIST CODl AMOUNT DUB AMOUNT RCVD CKI/CAS CWD B 0 B R D PERMIT <br />01 I3al 1 �9�� I4n� /�.��,�� <br />