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UNDERGR NO TANK, Y 1601E HAiELION AVE,, 910 KI CA K �n�rr.c ftil <br /> ! CLOSURE WBANDONMENT r 1111phont (209) 160-91� K <br /> Ftrtrtrlrtrtrtrtrtt'ttr!rtrlKtrtrtrtrtrtrtrtrtrtrtrIttrtrtrtrtt°trtf <br /> APPLICATION rOP, PERMANENT/IEIIPORARY CLOSURE OR ABANDONMENT IN PLACE Or UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EIPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE IELOVI <br /> _1(_ REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> EPA SIIE I CAC 000552416 PROJECT CONTACT l TELEPHONE 1 Jim Thorpe Oil 368-6175 <br /> r FACILITY NAME Brayton and Sons Inc. L PH—ow-1 (209) 838-7388 <br /> A --- <br /> ADDRESS <br /> I 1745 Second St. r Escalon, Calif. 95320 <br /> L CROSS 91REEI <br /> Jackson <br /> 1 OVIIER/OPERATOR PHONE <br /> _Y Ramp av _a_h_n_vP _ _ <br /> C CONTRACTOR NAME PHONE 1 <br /> G --__--_-- Jim Thorpe Oil Inc_— _ (209) 368-6175 <br /> N CONTRACTOR ADDRESS CA LIC 1 CLASS <br /> T _-- 351 N. Beckman rdLodi• _Ca. 495699 A B <br /> R INSURER on file VURK.COMP.1 On file <br /> A =-- --------- --- __— ----- =—_ -- ----- <br /> C FIRE DISTRICT PERMIT 1/INSPIR <br /> I _ ___ Escalon <br /> 0 HONE 1 <br /> R AB LABORATORY NAME P <br /> Water Works (209) 838-3507 <br /> --�-- <br /> SAMPtJNO rIRM a SAMPLING METHOD brass tube-see N5 on removal r Ian <br /> TANK 10 1 TANK 511E CHEMICALS STORED CURRINILI CHEMICALS STORED PREVIOUSL <br /> T <br /> A Jt- .ly�� _�� 550 Fal. Diesel Diesel <br /> N 19- <br /> DATE INVOICE . AMOUNT 11-57/615 <br /> WATERWORK 1210 <br /> 1710 MAIN STREET 4574 <br /> GEOCHEMIOAL 1 GEOWHNCAL 1 ENVIRONMENTAL ESCALON,CA 95320 <br /> PAY yam_ <br /> ARS <br /> DATE TO THE ORDER OF aRo11 AMOUNT <br /> o vea A1111.aArA111 DISCOUNT CHECK AMOUNT <br /> �/� ��Jn/ .lp�gbLii.✓ � rL,�� / <br /> ilAl FIRST INTERSTATE BANK of California <br /> 325 EAST F STREET OAKDALE,CA 95361 <br /> SIGNET_ ----- ,<L```{` = "'c--------------_-----------` - - -------------- <br /> OfFfrf IrE AO I/--EA 2J 11A Illi <br /> Itlllllllllllllllllllltlllllllllttlllllt1111111N1{Ir11111N1{IItNNIt111111N111N{{NIIIINIIINI{NIIIItNII{NIt111F <br /> SWEEP9 1 I COMP 1 I LOC CODEI_DISI CODE AMOUNT DILE 7IOUNI RCVD I CKI/CASH I ACD Y I DATE RCVD I PERMIT <br /> y�'G- <br />