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t't}:kt'ki' Ili Wit:tit:a,t ti�ti��k;:k;:k;:k}: <br /> ` dPP61 01 FOR PERMIT k: SIR JOIpUIY LOCAL HEALTH DISrRICTk: <br /> k: UNDERGROUND TAX[ f 1601 E HAIRLTON AVB., SiDCKTQYu�Ik; <br /> }: CLOSURE OR ABANDONMENT t: Telephone 12011 161-1120 <br /> itt'li�ti�ti�ii tt'ti:ti�tti tii�ki ti�tY ki�t}�tY TETT tip k}:ti�ti'ki�ti�ti�ti�ti�tt�ti�tBti�N: <br /> 1PPLICITIDN FOR PERMANENT/TEMPORARY CLOSUII OR ABAYDOMNEHf IN PLACE OF UNDERGROUND HAZARDOUS SUBSTIHCES STORAGE FACILITY <br /> THIS PERMIT EMPIRES 90 DAYS FROM THE APPROVAL D17E, DO lot 9117E IN ITT SIIADII AREAS. INDICATE PERMIT TYPE IRLOY: <br /> xREMOVAL --_ TEMPORARY CLOSURE <br /> ____ ABANDONMENT IN PLICf <br /> EPA SITE CAC On PROJECT CONTACT A TELEPHONE I �— <br /> F FACILITY NAME (1 n ,/ �^ <br /> JJ// PHONE I /, cLc <br /> A ( 1 93�s <br /> C ADDRESS S <br /> 1 - 9s <br /> L CROSS BARNET I <br /> I I (� <br /> r o1HER orfelrpe� <br /> r PHONE <br /> T --�_-- -dao 9 <br /> C CONTRACTOR EINE <br /> PRONE I <br /> — -- <br /> o 8 <br /> Y CoNfilcfOR ;10ADDRESS /� _ <br /> 1 _ 1 D . QOY Jn� r C1LIC 1 CIL is v� <br /> R INSURER II <br /> d — X 11 �l/f VORK.COMP.I <br /> C FIR[ DISTRICf <br /> T PERMIT I/INSP11 �— <br /> 0 LABORATORY NAME <br /> 0 r ( r� �!] i) I lr -nF PHONI <br /> E /oZ091 l to��r��S�_ <br /> SAMPLING Fight - ` <br /> — WY[UWUWYWYWIIDYYIRYYIWRIIMY RYytlUWI'WYDYDY nvl'CO,ZrA f SAMPLING NEfIOD <br /> TANK ID 1 " S' _ <br /> f TIIK SIZE CORMICILS STORED CL'RREIITL CHEMICALS STORED PRIVIOUSL <br /> ]9- <br /> IWIIYWWWIVI'WtlYUYYIYYIMOWIWYWWIYYtlYWIIIYWIWYtlutlDYIYY. IIWWI!401WIIIIIIiYaIUIIUW13u II¢!7114TH!YVWJ6WlIIWWtuVW9ud9WWllillluWuuYuO1FII7JII6'illi'IYNEEDED <br /> WOY SEPARATE FORK <br /> P �_ APPROVED <br /> L - CCNDI110NS lPPROPID WITH JUW:DtlutDWIYYYUYIYYRtluYtlYVpLWXMYWVNWYIYN <br /> - — DISAPPROVED <br /> 1 PLAN IIVIIIIIS MIME SEE 11TACY NT WITH CONDI110YS) <br /> YUWNWIIWYIYDIYI[WIBRYNWYYWWYIYYIItlYYWIR6YNXYDWYIYYItlWDtlWl1'YWyyyWZYYpYtly�yyl <br /> APPLICANT RUST PERFORM ILL YORK IY ACCORDANCE YIiH SAN JDIpU1N COUNTY ORp(glyTBLIUS,Y l RULES !ND RECULI}IONS <br /> OF THE SAY JOAOUIN LOCAL HEALTH DISTRICT. OYMER OR LICENSED AGENT'S SICYlTURR CERTIFIES IES TNB FOLLOY[YC: #1 CERTIFY TNIf <br /> IY TRE PERFORNANCI OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SNdSl NOT EMPLOY AFI PERSON IN 091SUC1 MIYNIR 1S f0 BTHAT <br /> SUBJECT 10 YOflKER'S COMPIYSItION LAYS OF CALIFORNIA,# CONTRACTOR'S HIRING OR SUBCONTRACTING SICNITURE CERTIFIES THE <br /> FOLLOWING: #1 CERTIFY THAT IN THE PERFORMANCE Or VIE YORK FOR WHICH TATS PERMIT IS ISSUF,D, I SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKIR'S COMPENSATION LIPS OF CALIFORNIA. <br /> CAL POR IN PECTI,ONS AT LEAST 40 HOURS IN ADVANCE <br /> SIGNS J <br /> OFFS SI ONLY•-Ell 1J 016 1?/ � DATE s - <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS$$SSS �'^ <br /> SWEEPSI I—COMP I LLOC <br /> C( DIST COOEI —1MOUYTSDug <br /> ISSAMOUYiSRCypSSSStCTS'ICAS1SSSSSRCFDSBYSSSSSSD11HspCVDSSSSSSSpERMI1SiSS <br /> - 1---- �__ 1�___-L_=;�__1 _- <br />