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rt;-tt-tt-tt-tt-i t- tt.ttt- tt:tt- tt- tt- tt- tt-tt-tt ti: ti: ti: tt-tt-tt-tt:tt- ti: ft. t tt- <br />` b: APPLIC1TIUr TOR PERMIT Sim JOIQUIN LOCAL HEALTH Dl St 4 tt: <br />t: UNDERGROUND TANK t: 1101 E HAIBLTON AVE., STOCKTON Clt: <br />t- CLOSURR OR 111NDONMIWT t: Telephone (209) 461-3420 t: <br />t-tt-ti: ti: tt-ti: ti: ti: tt-tt- tit: tt- ti: tt-tt-tt-tt- ti, t-t-tt- ff. tyR:tt-tt-tt-tYR:ti: tt- ft: tt-R: P-4 y <br />1PPLICITION FOR PRRMIYINT/TEMPORIRT CLOSURI OR ABANDONMENT IN PLICR OF UNDERCROUND HIIIRDOUS SUBST CES t~&ig5 I�ITY <br />THIS PERMIT EXPIRES 90 DAIS FROM THE 1PPROVIL D176. DO NOT IIITI IN III S11AD11 AREAS. INDICATE � TYPE 1BL0�'O <br />X REMOVAL N_ TEMPORARY CLOSURE _ 1811DONMBNT IN PL1CI V�RDNF <br />L <br />P1 S[TY I CAC 000191543 PROJECT CONTICT i TELEPHONE I Gary Trum ���� I4nR-?Q9_nQ9n C�� <br />F FICILITY MIME Breuner5 PHONE 1 <br />1 209-476-8151 <br />C ADDRESS <br />I 7676 Pacific Ave. Stockton <br />L CROSS STRYII Hammer Lane <br />I <br />f OVYER/OPERITOR PHONE <br />T Breuner's 415-866-4300 <br />C CONTRICTOR NINE Trumpp Bros., Inc.General Engineer. PHOMB 1 <br />0 <br />M COWTRICTOR 1DDRISS C1 LIC 1 CLISS <br />T 1540 Industrial 324079 A <br />j IYSURIRContinental CAS (CNA-S.F.) <br />) VORK.COMP.1 704717641 Exp. 7-1-90 <br />C PIRG DISTRICT PERMIT I/IYSPTR� <br />T Stockton Fire Dept. <br />0 LIBORITORY MIME Brown & Cal dwell 1 PROVE 1 415-428-2300 <br />R <br />SIMPLIWC FIRM' <br />P <br />L <br />1 PL1M YYV[EYERS MIME <br />N <br />-...F.r...i.cke I SAMPLING METIOD <br />TANK SIB CHBMICILS STORED CURRENIL CHEMICILS STORED PRIVIOUSL <br />10,000 Diesel <br />LIST IDDITIONIL TANK INPORMITION IS NBEDBD ON SBPIRITB FORM <br />APPROVED _1PPROVRD WITH CONDITIONS _ DISAPPROVED <br />(SBI ITTACHMEMT WITH COMDITIOWS) <br />1PPLICIYT MUST PERFORM ILL VORK IY ICCORDINCE WITY SIM JOlOUIN COUNtT ORDIY/YCIS, ST/1B LIES, IMO RULES 1N0 R¢CULIt[ONS <br />OF THB SAW JOAOUIN LOCAL HEILTH DISTRICT. OWNER OR LICENSED ICEYT'S SICYITURY CERTIFI¢S TNI FOLLOWING: 'I CERTIFY TUIT <br />11 Tit PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHILL Vol EMPLOY IVY PERSON IN SUCH MIWWER IS TO DECOR <br />SUIJICT TO VORKIR'S COMPINSIV ON LAYS OF CALIFORNIA.' ComICTOR'S HIRING OR SUBCONTRACTING SICNITURY CERTIFIES <br />FOLLOVINC: 'I CERTIFY THAT IY THE PERFORMIYCY OF THY Vol, FOR MWICH THIS PBRMIt IS ISSUEDTNB <br />, I SHILL EMPLOY PERSONS SUBJEC' <br />TO YORKER'S COMPIMSITIOY LIVS OF CILIPORYII. <br />CALL FOR I ECTIONS AT LEAST 48 HOURS IN ADVANCE <br />SIGNED OITY F� ;7— �n <br />OFFICE USI OYL H 23 04 12,� - <br />SSSSSSSlSSSSii SSSSSSSSSSSSSSSSSSSSSSSSSlSSSlSSSSSlSlSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSlSSSSS!lSSS <br />SWEEPS 1 I COMP 1 I LOC CODE (DIST Cool 1MOUVT DUE I IMOUMT RCVD I CKI/CISH I RCVD IT D1TI RCVD I PERMIT I <br />