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t'tT;tx-tyffti: txmtx.yrtvm:tx.tx.tx.tttx:tytx.tx.tx'tvtx.tvt .tx.tx.tVftRRIVtx-tx, <br />v IPPLICITION FOR PERMIT g 311 JOIQUIN LOCAL HEALTH DISTRICTt: <br />t: UNDERGROUND TINT t: 1111 R HAIRLTON IYR., STOCKTON elf. <br />t: CLOSURE OR 111NOOWNEIT t: Telephone 12011 111-3121 t: <br />t <br />IT. tx: tx, R it. ft ty tx.tx. tvv tx'tx. tx-tx. tx tvty tx. tl f. tx. tx tx. ti: tx:ft ft tx: tV ft tv tx: <br />IPPLICITION FOR PIIKIWBIT/11HP0111Y CLOSUII OR IBIIeDONHEIT IN PLICI OF UNDERGROUND 11111DOUS SUISl1NCBS STORAGE FICILITY <br />THIS PBRNIT EYPIIRS 11 DAYS FROM THE IPPROVIL 11179. DO NOT WRITR IN ill SIIADtl AREAS. INDICATE PKINIT TYPE IILOW: <br />211HOVAL - TEMPORARY CLOSURI _ IB1NDONNBNT IN PLICI <br />EPI SITE I PROJECT COYTICT A TELEPHONE <br />F FICILiTIr MIKE CHANNEL MECHANICAL, PHONE 1 466-5991 <br />I <br />C 1DDRISS 1725 Sanguinetti Lane, Stockton, Ca. APR 31989 <br />I <br />L CIOSS STREET Cherokee Rd. ENVQu,N1M1-N7AL HFAL FH <br />vCCYI�CJ <br />1 <br />T 4IWIg10P8 TOR PNONI <br />C CONtRICTOR NINEPROIR 1 464-8333 <br />Stkn, Ser. Sta. Equip.- <br />0 <br />I CONTRACTOR IDDIISSCA LIC I CLIIS <br />808-820 No. inion St. 309105 c-61,SA <br />Q INSUIER -_G NORC.00NP,1 �s _39/ <br />1 -- <br />C FIRE DISTRICT G �. r s PERMIT IIIWSPIR <br />T <br />0 LIBORATORY NINE Calif. Water Lab. PHONE I <br />R <br />SAMPLING FIRIIt SIKPLING HITIOD <br />1tlgI Y1 UlY1lIIl <br />TARE ID I TINE SIZE r CHEHICILS STORID CURRIITLI CHEMICALS STORED PIIVIOUSL <br />wslm <br />T 1- 1, 000 Gal. Gas , tiC�49i 3 Nome �ud_e� <br />1 if-tea=a i — <br />I 31- <br />C <br />11- <br />LIST IDOITIONAL TINE INFORNITION 11 NEEDED OI SRPIRITI FOIL <br />F IPPIOVID APPROVED 1111_CUOLT14H_S_ '_D191 <br />LISE1 TTICHNINT IITN CONDITIOESI <br />I PLAN IIi1EY$ES NINE � ' '� � <br />IPPLICINT MUST PERFORM ILL WORE 11 ICCORDINCE WITH SIR JOIQUIN COUNTY OIDINANCES, STITI LIPS, AND RULIS 110 RIGULITIONS <br />OF TNR 911 JOAQUIN LOCAL IEILTH DIStRICT. OWNER OR LICENSED AGENT'S SIGNITU'RR CEITIFIRS Til FOLLONING: 'I CRRtIFY TNI? <br />IN THR PEIFORKIICY OF THE 101K FOR Y1[CH THIS PERMIT IS ISSUED, I SHILL NOT BNPLOI ANY PERSON 11 SUCI $11111 AS TO 1ECON <br />SUBJECT t0 WORKER'S COMPENSATION LAYS OF CILIFOR111.' CDNTRICTOR'S NIRIIG OR SUBCONTRICTING SIGNITUII CBITIFIRS tit <br />FOLLOYIIG: 11 CERTIFY till 11 THE PERFORNIWCE OF THE LORI FOR WHICH THIS PERMIT IS ISSUED, I SHILL IKPLOY PERSONS SUBJIC <br />t0 YORKER'S COMPEISITION LIVS OF CILIFORIII. <br />CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br />SIGRID BATE <br />OFFICE USE ONLY --go 21 Ili 12111 <br />i SWBIPS I I CONP I ILOC CODE I DIST COD4 AN= DUET IKOUIt RCVD I CIIICISI ` IcTD 11 1 DATE ICVD I PERMIT I <br />