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N <br />APPLICATION FOR PRR <br />THIS PERMIT EXPIRES <br />t thm ti: t tvait: rrtit: tvtfi't;-kv kk t;. ti: t;r t;. R: t;. t1d tnv a tift t;: t7t:ti: n: <br />k hPPLIWON FOR PERMIT t: SAN JOIIUIH LOCAL HEICW ISTRICTk: <br />k: UNDERGROUND TIME t: 1601 E HIZBLTON AVE., STOCKTOI Cit: <br />k: CLOSURE OR IIAMDONM¢IT k: telephone 12091 168-3120 t <br />ENT/TEMPORIRY CLOSURE OR 18ANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br />DAYS FROM THE IPPROVIL BITE. DO NOT VRITB 19 111 SHADED AREAS. INDICITE PERMIT TYPE BELOW: <br />tom` REMOVAL TEMPORARY CLOSURE _ ABINDONNENT IN PLICE <br />PROJECT CONTACT A TELEPHONE I �Yc, Cd' ltsl¢o <br />EPA SIT¢ 1 _='d��.Z- `,II3 —SSII 3�7 <br />r p' <br />._ <br />F <br />FACILITY MAMPS. •1-- <br />d <br />C <br />ADDRESS <br />L <br />CROSS STREET - - - <br />— <br />T <br />OWNER/OPERITOR PHONE B <br />CONTRACTOR NINE PHONE I Zcri — ` -b2- WW <br />C <br />N <br />CONTRACTOR ADDRESS'fes,!`—jam5� CA LIC I_C7; CLASS A <br />R <br />INSUll, VORK.COMP.t <br />�— <br />PERMIT I/INSPTR <br />C <br />FIRE DISTRICT <br />0 <br />LIBORITORY NAME F -i, HONE E 476_--- <br />R—�— <br />SAMPLING FIRM' I SAMPLING METHOD g Q- <br />- U!Ut9NNUUiNHWUiUIgYYl4'Nq!NDNYY!Dgl'OgiUIYI'�gqUiCliil!q'YiGYI-'-'-"------�_- . <br />STORED PRH'1IOUSL <br />TANK IDI IIKK S-IZZEE, IC!IEHICILS STORED CIVIREXTO CHEMICALS <br />--------- — <br />39 - <br />LIST ADDITIONL TdNK INFORMATION AS NEEDED ON SEPAR179 PORK <br />UUUUgYWIIINIDtIYAUgIIIIIUUROiiiIUIVI' ODURYI' DIIgtIP✓JiIUU!YIIIJU' w!IIYDIDIigt!L"IillliliNlld'il!IC!iDICiIIIi901'W'!II!pq:Yg16YIIYICIkIN!+13CVUilUN;DDp9GJ"."'�I:'UL!i74RICYgItlI!YU9DI!'8111NUCDIUL'IWIIDIIII91gldH!gYDII1Y11611D!Ylillgigl9GINIlIq'6'IYYIIHtlN <br />P.I� _ ApRomf APPROWED WITH CONDITIONS _— DISAPPROVED <br />L (NES ATTACHMENT WITH COMDITI013) <br />A PLAN REVIETERS NAME —_ DdfE / <br />tl <br />YUN�NIYgNldO@IOIWUDNiYOiW ' tNUWOUYWAIOR4Dtl11 - ' IEUNN�'OI'+�.��.a4:1°?o6il�glliDYJ�ItlGIWONNRU9tgIKOVNWHgiGHtlHgYWdUOIUYYFGWtlYOBWYW'NYIUBIBOIWYIIIBNI-IYUINYpIHni <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE KITH SIM JOAOU1H COUNTY ORDINANCES, STITE LAYS, IND RULES IND REGULATIONS <br />OF THE SIN JOAOUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNITURS CERTIFIES THE FOLLOWING: 'I. CERTIFY THAT <br />IM THE PERFORMANCE OPITHE WORK POR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MIKNER AS TO BECON <br />SUBJECT TO YORKER'S CPMPENSITION LIPS OF CALIFORNIA.' CONTRICTOR'S HIRING OR SUECONTRACTING SIGNATURE CERTIFIES TH E <br />T IN THE PERFORMANCE OF VIE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SU.— <br />FOLLOWING: 'I CERTIFY THAT <br />TO YORKER'S COMPENSATION LIVS OF CILIFORNII, <br />CALL FOR INSPECTIONS AT LEAST 40 HOURS IN ADVANCE <br />SIGNED_ ---- <br />J OFFICE USE ONLY—VI 13 016 11/dl--_-----------_------ <br />iSS6SSSSSSi6SSSSSSdSSdS�SSSSSSSSSSdS99SSSSSSSSSSSSSS69SSSSSSSSSSS9IS$i$9$$$OSS$S�SSSSS{y4SS4IVSSSSSiSSSSSSSSSSSSv$S�SSS�iS <br />SWEEPS I I COMP I LO CODE I DIST CODE! I OUNT DUE AMOUNT RCVD I IC?CISH RCTO BY 111E RCVD PERMIT 1 <br />L_1Z5�� OKRY�a td�, 32 3 ; ZT.O� <br />