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ttt it it it it Cttt it N tit it h,R-t t it it it it 0 tt't t tt a it:it;tt tl it it:tt tt Gt <br /> t: APPLICAII OR PERMIT t SAN JOAQUIN LOCAL HEALTH DI CTI <br /> t: UNDERGO TANK t: 1601 E HAZELTON AVE., STOCK CA t. <br /> t CLOSURE OR ABANDONMENT t: Telephone (209) 460-3420 t <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> XX_ REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> EPA SITE t CAC 000180945 PROJECT CONTACT t TELEPHONE 1 Don (209) 957-9170 <br /> F FACILITY NAME PHONE 1 (209) 957-9170 <br /> A NOR-MAC, Inc _—_ ----- - ---- <br /> C ADDRESS 6215 Tam O'Shanter, Stockton , CA <br /> L CROSS STREET Swain Road <br /> T OWNER/OPERATOR NOR-MAC, INC. PHONE 1 (209) 957-9170 <br /> Y <br /> C CONTRACTOR NAMEjim Thorpe 011 , Inc. PHONE t (209) 462-4581 <br /> 0 --- _— <br /> N CONTRACTOR ADDRESS 351 N. Beckman Road CA LIC 1 495699 _ CLASS A, Haz <br /> T --- <br /> R INSURER on file WORK.COMP.1 on file <br /> A -- — ----- --------- <br /> C <br /> -------C FIRE DISTRICT City of Stockton PERMIT t/INSPTR " <br /> T _ -- <br /> 0 LABORATORY NAME Canonie Environmental PHONE 1 (209) 983-1340 <br /> R — — — <br /> SAMPLING FIRM* same SAMPLING METHODSee #5 on removal plan <br /> TANK 10 1 TANK SIZE CHEMICALS STORED CURRENTLY CHEMICALS STORED PREVIOUSL <br /> T <br /> A 39 12-5-e 1 ,000 _ Unleaded gasoli e <br /> N 39 <br /> --------------------------- <br /> K 39 <br /> 39 --------------------------- — <br /> --------------------------- <br /> 39 <br /> --------------------------- <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> P ____ APPROVED VAPPROVED WITH CONDITIONS DISAPPROVED <br /> L (S ATTACHMENT WITH CONDITIONS) FF <br /> A PLAN REVIEWERS NAME __ G3r__ ------------------- ...N �_f <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 1S ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SIGNED S .- DATE -6/8/89- <br /> -- ---- - -- --- -------------- <br /> OFFICE DSf OILY <br /> lffftfffff{f1{f{ifff{tf{tff{fffff{{tftfffffff{tffiffftff{tff{flftftif{fffi{fft{{ftftfffffttffffff{tf{ffftffftf{ffftffffff <br /> SWEEPS 1 �OMPr1 LOC CUE DIST CODE AMOUNT DUE I AM014NQ RCVD I /�— !C RCVS DAY �pTEjRC4pI PERMIT t <br />