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k fti tR't%1I tR'tii'tl a tt ut2'tt tt-tt ti'I%tt:R:k1'ti titYa tt tt'tt <br /> e APPOTION FOR PERNIT SAN JOIVUIN LOCAL NEILTH DISiRICTt: <br /> t UNDERGROUND TANG t 1101 E HAIRLIOY APB., STOCC101 Cit <br /> C' CLOSURE OR 111NDOUNENT t: Telephone (701) 1{8-)130 <br /> 01;1111 tntt'ti tilt ftll tl V11 V tl ti it ti'tt-tt Int tt.kr t'a ti'ti ,////4� ��/►f'p r <br /> IPPLICITIOI FOR PERMANENT/1EMPORIRT CLOSURI OR IRANDONM¢NT IN PLACI OF UNDERGROUND NIYIRD6 � f1 �3!diB ACE'P�ILITT <br /> THIS PERMIT EXPIRES 10 DAYS FROM THR IPPROVIL DITR. DO NOT WRITE IY 111 SIIAD[1 AREAS, INDIICC/I}EVfNR1�� 41YN 'IfNOYt. <br /> F REMOVAL --- — <br /> TEMPORARY CLOSURE ►UIYDONMBMI IN PUCE <br /> EPA SIT[ I�p ,� 7 PROJECT CONTICT A TELEPHONE I <br /> P FACILITY-NAME�� <br /> A De t. of Devel . Stockton PHONE <br /> (916) 948-7411 <br /> C IDDREIS ---- <br /> I Stockton Developmental Center sib m o . <br /> rte G carr k �i <br /> L CROSS STII[i 0 <br /> 1 OYNBR/OFIAITOR - <br /> T State of California PUON[ I (916) 445-3044 <br /> C CONTI►C10R YIMI �— <br /> 0 Placer Tractor Service PHONE I (916) 65205535 <br /> 1 CONIRICIOR IDDRESSP 0 gox 170 Loomis , CA 95650 <br /> T C► LIC I 440591 CLADS <br /> A <br /> R IYSVRIR Motherlode Insurance^— — YOAY,COXP.I <br /> C Flp[ DISTAICt—� PERMIT I/IYSPTR==-�-- <br /> 1 v <br /> 0 LA80R1TORY NAME Alpha Labs --- <br /> R PHO.¢ 1 (707) 468-0401 <br /> SIMPLIYG FIRM' Alpha Anal tical Labs SAMPLING M¢TYOD _ <br /> '- YYICYNtAKWAi0kapYyyNYNDYY.N4'IRWYYm _ Luft Program <br /> TAXI IDR i11C SII¢ <br /> T CHEMICILS STORED CURRENTL CHEXICILS STOIED PANVIOVSL <br /> L T C) --- -- ------ <br /> C 11 _ <br /> LIST IDDITIONAL TANK INFORNAIION AS NEEDED ON S¢PARITR FORM <br /> P YIWYYYYNR6�YYYNI7YAi.71RiY�Y91W'.11WYWYWtIWY4YkYE'W�.'IYRNW7YitWYiYWiti'NikYYd4Y�Y911WYIWYWIIYDYIIYI <br /> L -- APPROVED --IPPROPED WITH CONDITIONS DISAPPROVED <br /> I PLIN REPIEYERS MIME (SIB ITIACUMIYT WITH CONDITIONS) <br /> IPPLICI.T MUST PERFORM ILL YORK IY ICCORDINC[ ills SIN JOIOUIN COUNTY ORDI.IYCES, STI B91YS, AND RULES IND I/GULI110HS <br /> OF THE SAY JOAOUIY LOCAL X¢ALTN DISTRICT, OWNER OR LICENSED AC¢N1'S SIGNIIURA CERIIFI¢S THE FOLLOWING: '1 CIETI/Y TNI1 <br /> 11 THY P¢PFORMANCY OP THE YORC /OA WHICH HIS PER IS ISSUED, I SMALL 101 EMPLOY INY PERSON IN SUCH MANNER 1S TO RECOM <br /> FOLLOWING: <br /> TO 'I CERT COMPENSATION LIES OF CILIFORYIA,' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CIAiIFI[S THE <br /> /OLLOYIIC: 'I CERTIFY TN1T IN THE P¢RFORMINCE OF TIIY YOYS P02 WHICH THIS PERMIT IS ISSUED, I SIIILL EMPLOY PERSONS <br /> 10 VORXER'S COMPENSATION LIPS OF CILIFORVII, SURJ[C <br /> CAL 0 INS CTIONS AT L13AST 40 IIOVRS IN ADVANCE <br /> SIGURD- <br /> OFFICE VSA ONLY •111 1] ON{ If/it <br /> sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssslssss <br /> SYE¢PS 1 I COMP I I LOC CODE ( DIST CODE IMOVYT DVYI AMOUNT RCVD I CKI/CASH I EY I 0111 pCVD- PERMIT 1 <br />