Laserfiche WebLink
*1/04/99 17:03 <br />0209 465 7244 <br />PORT OF S'TOCKTQN <br />003 <br />SAN JOAQUIN COUM PUBLIC HEALTI1 SERVICES <br />E " WvgRONMENTAL HEALTH DMS'ION, <br />AppLICATION FOP, UMERGROUND STORAGE TANK CLOSURE PERMIT <br />TFE MIT FOR <br />YTONTEMDSSUBSTANCE <br />ST9RAGYANK <br />EXPIRFS 911 CASFROMTHE APPRO ALDAE. D OT WRIIN ANY SWOED AkEAS. INDICATEICATE ERMIITTYPE BELOW• <br />X <br />RE)ICVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br />EPA SITE a Cly OOO J.r71 PROJECT CONTACT & TELEPHCNE # BAYM E. NIC <br />TIOL,9CN <br />F FACILITY }LAME PORT OF �I PHONE # 202�'94.0--0246 <br />A <br />C ADDRA SS 2201 WEST' WAMNG'IN STTM- T, S� C C�A_rW, CA 95203 <br />L CROSS STREET M ATTACHW SITE MAPS AR EACH TA''K (4) <br />T "ER/OPERAYOR PHONE 209-946-0246 <br />C CONTRACTOR NAME <br />JTX TMIJEE OIL IX. PHONE # `7 368-6175 <br />d ROAD, CA LIC "495699 cuss A/13/"MZ <br />N CONTRACTOR AOORf5531`1'rj �'� C}tD,� <br />T UORK.COMp.# 109,5135-9 $ <br />R I N SURER GL ITAR f� IiiiS MICE <br />C FIRE DISTRICT My CE STOCK-" PERMIT * ON APgAL, <br />T- -- pp •~- CO13NTY JQAIlV PHONE # `20.--� Yf '1- <br />0 LAOORATORY NAME.+ I t �1 1 e <br />A AN <br />PHONE( # Saw as above <br />SAMPLING FIRM Sam as above <br />1!I U 11111111!llllllllll1111li „�pl� SI � ORED CURRENTLT/PREVIOUSLY 31&-ff by <br />TANK 10 it 1 -�UUV �PSZ ) <br />39-^ - ! C.7 s3�fi� F <br />T 39- �` rm snl n� �� 1 anr� <br />A 34- <br />N 34 IN <br />Alt <br />K 3 --- <br />39- <br />n39- <br />u IIl !11111 1 1111! Ifff11111111 11 11111111 Illliill ! 11tI1I111111i 1 1 11111111I1111TIT <br />P APPROVED APPROVED VITH CONCITION(S) _ 01SAPPROVEEI <br />L "— (SEC ITIONS BELOW AKDfOR ON ATTACHMENT) <br />A ! <br />N AAT£ I-"' n <br />%✓` �2S 'Z <br />PLAN REVIEWERS NAME-- <br />1III IHIM IlIII 111III HIM III 111I11lIlIlilllll III] HIM 11111111111111111I11111i111IlI1tI111[llii11I111lIllIlillll[Ullllll <br />APPLICANT MUST PERFORM ALL WOW: IN ACCORDANCE uITH SAIL joADLI3N COUNTY ORDINANCES, STATE LAMS. AND RULES AND REGULATIONS OF <br />SAN SOAAUIN COUEITY PUBLIC HEALTH SERVICES_ OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOUIIRG: "1 CERTIFY THAT IN <br />THE pFRf0RKANCE OF THE WORK FOR VIIECH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PeRsON 12 SUCH A MANNER AS TO 9ECDNE <br />LAWS [IF SLMJECT TO <br />CERTIFY THATEIHST CoMPENSATION <br />t>F THE WORK DRAWilICNDT LRSFER?IITTORiS NIS;Is5UEn, ING OR CSHALLLL EEMPLOY ING IPER50Ns SRIBjECTGATURE ETOTWORHE KERRIO4iiH&. <br />CG"ENSATIOX LAWS OF CALIF Nik.�' F az�'ixs <br />+ TITLE SPECIMAST DATE E llq)l <br />APPLICANT'S SIGNATURE: <br />CONDITIONP: <br />EH 23 046 (Revised 9111/96) Y4 �A ge•3 <br />