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GlL It lI'tiJ2t ffftG .R:tir tT:tL'Mr1t;tr tv tr R.rC t"I.,tie t2.kYAz.M <br /> e APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT a rj}1 <br /> t UIDERGROUND TANK t 1601 E HAXILIOR APB., STOCKTON Clt: ✓. <br /> r CLOSURE OR 1111D0NKEIT t telephone 12091 168-7120 <br /> t tt�lt�t;�tYlt�N�t;�lYtS�tt?it2'tt�lY.t��tkt��tt:t��tt'tk tk�tt ti�t��kt�tYt�k;:tYtYtYkB <br /> APPLICATION FOR PERMANINTITEMPORIRT CLOSUII OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTIICES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 0115 FROM TIE APPROVAL 0171. DO NOT III71 IN IRI SHADED AREAS. INDICATE PKINIT TYPE IRLON: <br /> METHOD OF CLOSURE/T'O BE DETERMINED <br /> ✓— REMOVAL — TEMPORARY CLOSURE — ABANDONMENT IN PLACE <br /> EPA SITE I PROJECT COITICT i TELEPHONE I Sandra Getz (916) 440-494 <br /> �Ac-'9001(' L s /` Associate Asset Manajaer <br /> F FACILITY MAKE Denevi PHONE I N/A <br /> 1 <br /> C ADDRESS 5555 Shippee Lane, Stockton, California <br /> I <br /> L CROSS STREET <br /> I <br /> T OWAER/OPERATOR Wells Fargo Bank, Trustee PHONE 1 (916) 440-4941 <br /> T <br /> C CONTRACTOR NINE See cover letter PHONE I <br /> 0 <br /> I CONTRACTOR IDDRRSS CA LIC I CLASS <br /> R INSUBBR WORK.COMP.1 <br /> A — — -- <br /> C <br /> t FIRE DISTRICT San Joaquin County PERMIT I/[NSPTR 89-0081/Cunningham <br /> 0 LABORATORY NAME ,PHONE I <br /> R 67"'Lj <br /> SAMPLINCRMI <br /> SAMPLING METHOD <br /> OMIRKNRONNRNDOD�tNNOR111RRRNNON <br /> TIRE ID 1 TANK SIRE CNIMICILS STORED CURREI?LI CHEMICALS STORED PREVIOUSL <br /> T <br /> A 79 � Zlr✓ - cit ��J Z <br /> K 79- <br /> 79- _ <br /> LIST ADDITIONAL ?INK INFORMATION IS NEEDED ON SEPARITI FORK <br /> C4W�Kbl.'NdBitlNpHWIpODNURNNNU9 9NHBNIDRIWNNNDINK <br /> P "iPROVRD _APPROVED WITH CONDITIONS DISIPPROVID <br /> Lj _y %(SEE ATTACHMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NINE Om I��� � <br /> H -- <br /> RAI II'WpDItlIIIRNINNIINIIINNIGRimgpBRNDflNR10NE�pXIRNtlBq®gNDNWNNp�NINRYNIpNNNN <br /> IPPLICANT MUST PERFORM ILL YORK IN ACCORDANCE WITH SIN JOAQUIN COUNTY ORDINANCES, STATE LITS, AND RULIS 110 REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CIRIIFY THAT <br /> 11 THE PERFORMANCE OF THE IBEX FOR WHICH THIS PERMIT IS ISSUED, I SMALL HOT EMPLOY ANY PERSON IN SUCK M1NNE1 IS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LITS OF CALIFORNIA.$ CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES ANE <br /> FOLLOWING: 'R CERTIFY THIt Itl THE PERFORMANCE OF THE YORK FOR IBICH THIS PERMIT 14 ISSUED, I SHALL EMPLOY PERSONS SUBJIC <br /> TO WORKER'S COMPIXSITIOH LITS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 98 HIN ADVANCE <br /> Wells Fargo Bank -,NA.., Trustee <br /> SIGNED ,I OTE � 6PES R 9 5 <br /> OPPICB USE ONLY BN 2J 016 i J 0 S . ni e G.A.S PE l— <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS$SSSSSSSSSSSSSSSSSS$SSSSS$SSSSSSSSSSFS 9'�91��� + ���SSSSSSSSSSS$$SSSSSSSSSSSSS <br /> STEEPS ICOMP i j WC CODE DIST COI MOUNT DUE AMOUNT RCVD I KI ASH I R T DATE 1CVD PERMIT I <br />