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. .. <br /> ttztetztztztxtttzezurtztxtiE'ttztztctxtatxtte#txttitctztzrocctaettx <br /> t APPLICAilON ERMIT t SAN JOAQUIN LOCAL HEALTH OISTR <br /> a UNOERGROURRANK t: 1601 E HAIELTON AVE., STOCKTO y <br /> t <br /> CLOSURE OR ABANDONMENT t: Telephone (209) 468-3420 / <br /> Nt:13 b WOXfir;;.ta:ua:::tT;3xtt:Via:uc:;:::*:tr ;x n:nar lr.tx.Ixn:txn: <br /> DERGROUND <br /> DOUS <br /> TAXES <br /> GE <br /> THISIPERMIT PERMANENT/TEMPORARY <br /> SEFROMATHECAPPROVALRDATE. DOENOTIWRITECINDANYNSHADED AREAS. INDICATES PERMIT TYPE BELOW: <br /> FACILITY <br /> FOR BELOW <br /> X REMOVAL ----- TEMPORARY CLOSURE __-_ ABANDONMENT IN PLACE <br /> PROJECT CONTACT 4 TELEPHONE 1 Poi ke Fowler <br /> EPA SITE 1 CAC 000191133 _ 209 464-8311 <br /> F FACILITY NAME California Water Service Company PHONE 1 (209) 464-8311- - <br /> F --- <br /> C ADDRESS corner of Plymouth Street & River Drive, Stockton, CA <br /> 1 — <br /> L CROSS STREET River Drive <br /> T OWNERIOPERATOR California Water Service Company CANE 95205 (209) 454-8311 <br /> Y 1602 E. LaFayette Street, Stockton, <br /> C CONTRACTOR NAMEJim Thorpe Oil , Inc. J� PHONE 1 (209) 462-4581 <br /> _ <br /> 0 -- <br /> N CONTRACTOR ADDRESS 351 N. Beckman Road , Lodi , CA CA LIC 1 495699 CLASS A, Haz. <br /> T WORK.COMP.t on file <br /> R INSURER on file _ <br /> C FIRE DISTRICT City of Stockton PERMIT t/INSPTR <br /> 0 LABORATORY NAME Canonie Environmental PHONE t (209) 983-1340 <br /> R SAMPLING FIRM, same SAMPLING METHODBrass tube-see #5 on Removal P an <br /> TANK ID 1 TANK SIZE CHEMICALS STORED CURRENTLY CHEMICALS STORED PREVIOUSI. <br /> 1 Re ular Gasoline <br /> A ��---------- 550 <br /> N39---------------------------- — <br /> K39---------------------------- -- <br /> 39---------------------------- <br /> 3 LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPtllll�P ____ APPROVEO APPROVED WITH CONDITIONS ____ DISAPPROVED <br /> L E TTACHMENT WITH CONDITIONS)A PLAN REVIEWERS NAME ---- � --- DATE - j <br /> N <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING; 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING; 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FOR INSPECTIO AT LEAST 48 HOURS IN ADVANCE <br /> SI8NE8 _ ___ Vice_=P_r_e_-_-_d_e_n__t__--_-__________ GATE__ July-6,- 1989------ <br /> OFFTCE BSE --EN 21 OY6 12118 7 <br /> ssssss+s+ssssss+ssssss+ssssss+s+sssssssssssssssss+ssss+ss+t++ss+ss+ts+ssssss+st+sttEss++sssts+sssss+ssssssss+tts+stssstss <br /> TIPS COMP 1 LOC CODE GIST CODES AMOUNT DUE I AMOUNT RCVD CKIICASH I -RCVD BY DATE RCVD PERMIT f <br /> (o s�. <br />