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s II• uN UG,.uI\uVlvU 1Hpf\� �I tl1V♦ L' IItl LLL. , i,l. hr t .. LVl.1\ 1111v l-N li <br /> 4I CLOSURE OR ABANDONMENT ii Telephone 1 ?11'x1 4F,H - 341" <br /> APPLICATION FOR PERMANEINTEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND RAIAI'OOOZ SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT IRITR ll III SHARD AREAS. P0PCI11 PERMIT TYPE BELOW: <br /> � REMO!'AL TEMPORARY CLOSURE ABATATiO..N9MENT IN PLACE <br /> 1r-- ; PHONE # �l f AI -USCI <br /> F PROJECT C0NrTACT <br /> A ------- <br /> C <br /> C FACILITY N,�t E_ #� ADDRESS Et <br /> I "IRAC _RAxLl41 --.Z24g4 -7 St»eP Irrae� . <br /> L OWNERlY URAL 1 1120-. DISI f lC ADDRESS PO I I ] SAA 1i A... �Y53d� <br /> T jr CROSS STREET I PHONE N 40-!Z-1 S�ZS IRKS <br /> u Y i <br /> !___ 1L 1 <br /> Cr CONTRACTOR NAME I PHONE N -je/ <br /> _/ <br /> 0 it jm TH" OIL,�n� I _II <br /> 'I T it CONTRACTOR ADDRESS P. � 357 f Loo ) a52y1 CA LIC <br /> XIII R I LIC CLASS A I WORK . COMP . I INSURER I <br /> A <br /> C FIRE DISTRICT PERMIT # j <br /> "frtP�cY R L '5iac.J�lstr►c'1- <br /> T --BORA- - - -- i -q <br /> 0 LABORATORY NAME (1, � , 1 PHONE # UG,�-� _q83- <br /> SAMPLERS <br /> ^pNAME SAMPLING METHOD <br /> �I. CIul VOLUME CHEMICALS STORED DATES STnRET) CHEMICALS STORED <br /> H ID N i CURRENTLY PREVIOUSLY <br /> E <br /> ' M 1Tl TO <br /> I v . <br /> i TO _ - <br /> C I I TO <br /> A I I TO BOOB <br /> L LIS ANY EXTRA TANKS ON A SEPERATF _'4i.£ET <br /> L (SEE ATTACHMENT WITH CONDITIONSi <br /> _ :DATE: ..b <br /> ' A PLAN REVIEWERS NAME �Tf�IYLIE �J11.14_ V .�6 6 <br /> cnu'fuYulYllduNA�f�euTi�PiBNGIiitlPi Fltl�Xd��ixu�aua awwlini uul r sws:iu ian aliyooRdl�xilpn:Ydtlhm111114IwN <br /> APPLICANT MUST PERFORM ALL YORK IM ACCORDANCE YITH SAN JOAQUIN COUNTY ORDINANCES, STIT£ 11fS„ END RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OTHER OR LICENSED AGENT'S SIGNATURE CERTIFIES T11P. I'ILLOUNG: 'I CERTIFY ?HIT <br /> 1N THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY INT PBRSOW IN SUCH MANNER IS TO BECOME <br /> SUBJECT TO WORKMAN'S COMPENSATION LAYS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CONTNXCT19 SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE YORK FOR WHILE THIS PERMIT IS ISSNED„ ? SMALL EMPLOY PERSONS SUBJECT <br /> TO WORKMAN'S COMPENSATION LAYS OF CALIFORNIA. COMPLETE DRAWING ON ATTICIED PLOT PLAN SBf§7. <br /> CALL 4F�OLL NaSYPECTIONS AT LEAST lb HfZUR:- IN ADVANCESIGNED XTITLE: DATE: .-ACCEPTED B TITLE : _ _ DATE: ___ <br /> OAtl9tltlWUiidIIJ00?GRBIIIO'�NRIIIR�WIWRJWITNA01 ' �1BNSIAtl a �n3IMNIlt�"'"u�"d: SRNRYIIVAf1YdtlBI'd�Hl' <br /> INMUYW1111lINYIYIW�IIxYfWIXtlxMMMNuuuWIMtlMXWMURNMNA,MWgAMNYMIMWIAMNIMpPl11MINx WrypgIMwINNAMA1WMvnngMiV,f�h'BMMYLIInLML1rs��ry�'W a4,dnu,pWNMY1WYMM1�nMnlfl:x:N01nPIWn�b:iMI111WMIkAUAM <br />