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1eact1:44-141tttttt¢teal:tttttt11n0I1isnett#'titat$tt: tateiat3t>s <br />{ APPLICATION FOR PERMIT a SAN JOAQUIN LOCAL HEALTH DISTRICT r �%c �✓ />`�s � ,�„/ <br />D UNDERGS TANK X: 1601 E MURTON AVE., STOCK AW <br />t CLOSURE dR'F/ANDONMEMT E Telephom (209) 460-3/ 0 I�'((" u �V/ <br />:llil3l3lfilrlr!? ?: ti u:l !?l .!?.!?li!? Ctt?! Rx!'.la!?l4 ?l tfilTlY1�C \:/ N I <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDER61ROUNO HAZARDOUS SUBSJ� ES OWNCILIJTY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERT TYPE BELOW: <br />R EN PERMIT^/ SER L HEALTH <br />KREMOVAL TEMPORARY CLOSURE - ABANDONMENT IN PLACE VICES <br />EPA SITE 1 CAC 000191128 <br />PROJECT CONTACT f TELEPHONE I Mike Fowler <br />T 209) 464-19111 <br />F FACILITY MAKE California Water ServicePHONE <br />A Com anY <br />464-8311 <br />C ADDRESS 1646 Wagner Avenue, Stockton, CA <br />I <br />L CROSS STREET Secti on <br />I <br />T DWNER/OPERATOR California Water Service Company <br />PHONE 1 (209) 464-8311 <br />Y 1602 E. LaFayette Street, Stockton, <br />CA 95205 <br />Thorpe Oil, Inc. <br />PHONE 1 <br />(209) 462-4581 <br />=ADDRESS <br />51 N. Beckman Road, Lodi , CA <br />CA LIC 1 495699 <br />CLASS A, Haz. <br />file <br />WORK.COMP.1 on file <br />C FIRE DISTRICT City of Stockton <br />PERMIT 11INSPTR <br />T <br />0 LABORATORY NAME Canonie Environmental <br />R <br />PHONE 1 (209) 983-1340 <br />SAMPLING FIRM* same SAMPLING METHOD BraSS tube -see #5 on Removal <br />TANK ID 1 TANK SIZE CHEMICALS STORED CURRENTI. CHEMICALS STORED PREYIOUSL <br />T <br />9 _.�--_ <br />A 39--.—... <br />N 31- <br />---- <br />�-------­------------- <br />--------------- <br />------------------------ - <br />LIST A TIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br />APPROVED __ APPROVED WITH CONDITIONS DISAPPROVED <br />____ <br />L ,p��,/ /_ ATTACHMENT WITH CONDITIONS) <br />A REVIEWERS NAME 1.5 � �_._ <br />------- ----- -------------------------- <br />--__DATE_____ <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: 'I CERTIFY THAT <br />IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br />SU34ECT 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 INSPECTI NS AT LEAST 46 HOURS IN ADVANCE <br />SIGNER __. _ _ _- _ _Vice =President _ _pATE July_6,__1---------- <br />89 <br />- -- - --------------- - -------- <br />0fF10E BSE 0 If 41 13 Df6 11/18 <br />$6 <br />f{{ffffff{tff{ff{f{ff4{ftttfffitif{ fff{f{f{tfffff{ffl4ffffftffi{{fffiff{f{ftfttittfifff{f{{{i{ff{ffffffif{ffftffff{f{fff <br />SWEEPS 1 COMP 1 I LOC CODE I DIST FLOE AMOUNT DUE I AMOUNT RCVD I CKI/CASH RCVD BY DATE RCVD PERMIT t <br />an <br />