Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PER&fIT <br />THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IH PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br />EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br />x REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br />EPA SITE N CAL 000041551 PROJECT CONTACT i TELEPHONE N Jim Thorpe 011, Inc. (209) 368-6175 <br />F FACILITY NAME The Port of Stockton <br />A PHUNE N <br />(209}946-0246 <br />C ADDRESS 2201 W.- Washington St./P.O. Box 2089, Stockton, CA 95201-2089 <br />I <br />L CROSS STREET Navy Dr. <br />T OWNER/OPERATOR <br />Y Same as above PHONE / (209)946-0246 <br />C CONTRACTOR NAME Jim Thorpe Oi i , Inc.0 PHONE Y (209) 368-6175 <br />N CONTRACTOR ADDRESS p, 0. Box 357, Lodi, CA 95241 CA LIC 9 495699 CLASS <br />A, B, HaZ. <br />R INSURER Firemans Fund/Genstar <br />A WORK.cOMP.N 007197-97 <br />C FIRE DISTRICT-- <br />7'he City of Stockton PERMIT r <br />T upon approval <br />RO LABORATORY NAME GeoAna lyti cal Labs COUNTY San Joaquin PHONE r <br />(209) 572-0900 <br />SAMPLING FIRM A� 1 ical Laboratories PHONE B (209) 572-0900 <br />— lIIIIIIrII�INIII�`�111�Ir��r <br />39- � _ TA K SIZE CHEMICALS STOR D CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br />12,00 al unleaded gas uk <br />T 39- <br />A 39- --12 r3L_diesel Ljjej <br />N 39- <br />K 39- <br />39- <br />39- <br />P Illi (11111 <br />L APPROVED rr <br />A 'APPROVED WITH CONDITION(S) DISAPPROVED <br />-~ <br />N (SEE CONDITIONS BELOW AHD/OR ON ATTACHMENT) <br />PLAN REVIEWER'S NAME ry DATE <br />IIIIIlrllllllllllllllllrrlll1111rIII11111111rIIlIlillfrlr111111111Ilrlllllllllllllllll111111rIIIlIlI111111I1'Illllllllllllllll <br />APPLICANT MST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGEN'T'S SIGNATURE CERTIFIES THE FOLLOWING., "I CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWINGr <br />"I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA.Yif' 1 <br />APPLICANT'S SIGNATUREI 7 -N -1i <br />CONDITION(S)i <br />� . C". -¢ it's A -L)`�" <br />IN 23 046 (R6084d 9/11/9615 f e,6-,,4 -eoo 1�-sPage 3 <br />TLE Contractor/Agent DATE 2/23/98 <br />Al <br />Gum � e�c.e�•!z� c!w . <br />3 <br />'f�-, A� <br />r <br />