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I) U.vUL't\UI\VUIVU 1Nly f\ `� II lUUl <br /> �I CLOSURE OR ABANDONMENT ii Telephone 1209 ) 4fil- 3428 i <br /> � i <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDEAGROUN IAElR0085 IIISTANCES STORAGE FACIE�OL[T^/ <br /> THIS ,EAPIRES 10 DAYS FROM THE APPIOTAL DATE. DO NOT TRITE IN INY SHAPED AREAS. IIPICATB PERMIT TYPE BELOW: <br /> PERMI <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE: <br /> _ _ �•�/ <br /> 'r F 1 PROJECT CONTACT MIIf_ ,f i PHONE IJ�a�; <br /> A <br /> II C FACILITY NAME ADDRESS <br /> Js224 Pork RV( <br /> I 2 �._Sur.macS�k -_ t' Mang. <br /> I I� OWNER.. h'A ,. L _ Ram .p;ch lM ADDRESS T�S more- <br /> T it CROSS STREET Y I PHONE N —/ F 3-345J i <br /> t - - <br /> I( C I CONTRACTOR NAME Meo <br /> fl PHONE IT <br /> O <br /> _--....... <br /> TCONTRACTOR ADDRESS CA LIC N 1430.--._Garpeoter PJ., Nedesl'oi �h8,_'I <br /> II R LIC CLASS ^ CI WORK . COMP . N INSURER I <br /> A <br /> C FIRE DISTRICT T PERMIT I <br /> 0 LABORATORY NAME ////•JJ PHONE N <br /> R <br /> SAMPLERS NAME SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED I DATES STORED N CHEMICALS STORED I <br /> H ID q CURRENTLYPREVIOUSLY <br /> __ __. <br /> M f 11000 LL'UC)c-d j TO k <br /> L iTO --; ---- <br /> 1 C 1 TO � I <br /> �I A TO e (I <br /> L LIS ANY EXTRA TANKS ON_T SEPERATF' ;HEFT <br /> r l A mH I1II� �II y " Yfl 1A1[R 1Wq�hk �LJ7�;XWAn't'n;rIA�„WLAj,4IpAII �jI� yU I it <br /> (,'a Afl All M dlYlild114WL 119 A �� WIN ISI I�I I' p NII <br /> ii I a W�YWyWy Jv�4lhlllllW <br /> L (SEE ATTACHMENT WITH CONDITIONSI pl' <br /> A PLAN REVIEWERS NAME <br /> / N WYntll 1pl i 1 Y n'Yll�l�t <br /> W tl1AAINAIAWAWSW IAYAI 4AlIAIJIN.IAYNAI1ANWDATE <br /> �LN ��AlNN WXYI � MEREgAR INII flN 1CAtlY"R11II1I1IA1N8�'YdAAW"�UII A 111A1gwA1y�IY11�yryN�WWAAry�A^I�"NddN <br /> ' <br /> APPLICANT MUST PERFORM ALL YORK IN ACCORDANCE PITH SIN JOAQUIN COUNTY ORDINANCES, STATE LAYS, 0f) RULES AND RECULATfONS <br /> OF TIE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGIITURE CERTIFIES THR ?'"GLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF TRE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON t'N SUCH MANNER IS TO BECOME <br /> SUBJECT TO WORKMAN'S COMPENSATION LAYS OF CALIFORNIA.' COYTRACTOR'S HIRING Of SUB-CONTRACTING SIGNITURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, i 51ILL EMPLOY PERSONS SUBJECT <br /> TO WORKMAN'S COMPENSATION LAYS OF CALIFORNIA. COMPLETE DRAWING 01 ATTACHED PLOT PAIN SHEF.?. <br /> CALL FOR L NECESSARY INSPECTIONS AT LEAST T$ HOUR_- IN ADVANCE <br /> SIGNED X _— TITLE: ljo• Y.___ DATE: <br /> ACCEPTED SY TITLE: _ DATE: ___ <br /> wwmm <br /> E -- � <br /> HBAOAtlPINIBA9dICdtl�0l9llIWiI 1 � P1'�C5T1W + ___-- I Kd7WY7BIfJY,OBttlIPd9NAl <br /> NFP.WIWyA11/�IMII:IiYWY.HW11PdNPoAMyAIA[AYOMPoMMMAAI;WWIgAyyYNIYMy1111MMMNPHIIYIAMIAIYIWIMMMAIFI N'K'PIRA"IInNIIAY(#AINM�V.IIAA'!T.e"y,dAFII11Ai1M',AAn;.I:'.::WPMAYIRIf IA1".,A.i'Ifl:x'ry^WAIAIWnµA;,IMfRIYWMIWIN <br /> L <br />