Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENyIgON 4FNTAL B EALTH DIVISION <br />APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PER2vIIT <br />THE PERMIT FOR PFROMNTHE/APPROVALYDATE. DONOTBWRNITEMINTIN PLACE ANY SHADEDTF UNQERGRCUND AREAS. INDICATEAPERMITSTYPESSTORAGE TAMC <br />BELOW <br />EXPIRES 9 <br />1l� REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br />EPA SITE CAL 000O415J1 PROJECT CONTACT & TELEPHONE BARRY H. TvICHOLSON <br />PHONE # 209-921b-0246 <br />F FACILITY NAME PORT OF S'TOC K"10N <br />A 2201 WEST W-ASHINGTON STPLa'I STOCK' iV, CA 90203 <br />�.� <br />C ADDRESS ' <br />I <br />L CROSS STREET Sa ATTACHED SITE MAPS FOR EACH TANK 4 <br />1 PHONE 209-946-0246 <br />T OWNER/OPERATORPORT OF STOC KMIN <br />Y <br />C CONTRACTOR NAME <br />Jlbi THORPE OIL INC. PHONE #FCLAA�S <br />368-6175 <br />p CA L I C K 4956OGO B I]iiZ <br />N CONTRACTOR ADDRESS J51 NORTH BEMIAN ROAD, LODI, OA <br />T WORK.COMP.# 1095135--98 <br />R INSURER G�NSTAR/Ik ILDERER INSURP-NCE <br />A PERMIT # Ory APPROVAL <br />C FIRE DISTRICT CITY OF STOCK70N <br />Tt COUNTY SAN JOAQUIN PHONE # 209-942-0181 <br />0 LABORATORY NAME FGL <br />R PHONE # same as above <br />SAMPLING FIRM Sc�I11(', as above <br />II!111111111111IIlllllill11111 �A caHln TORED CURRENTLY/PREVIOUSLY L TM's-�H bS <br />TAN 250-10&'es t aS 1 j�1 v C <br />T 7 <br />395s-F2cJ(,OS <br />- �0-10 . <br />T 39 / I u j,Pct �a cnl 7 l tw F 1 04C)S <br />A 39-/ / �;�0-100 l est) r <br />N 39-1 r <br />K 39- <br />39- `y <br />39- <br />1111iff111llllllllll!!!lI11111 1!illlllll111i111i111l1lllllllll 1111111111!11!li11111i111iI111llllllllllllllllllllllillllllll <br />P APPRDW APPROVED WITH CONDITION(S) DISAPPROVED <br />L -(Set- (TIONS BELOW AND/OR ON ATTACHMENT) <br />N 4� <br />A Y DATE I b l �- <br />%J" <br />PLAN REVIEWER'S NAME <br />1111111111111111till 1111111111111111111111IlllllllllllllilflllllliI III till <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'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 />"I®CERTIFYY THATEINSTHEMPERFORMANCEAOF THECWORKOFORAWHICHOTHISCPERMITHISlNG OR ISSUED, I ONTRTING SHALLALCEMPLOY]GNATURE PERSONS SUBJECTES THE TO WORKERLSWINC: <br />COMPENSATION LAWS OF CALIF NIA." ENVIROIZ22 I L <br />f SPECIALIST DATE �� q �' D <br />APPLICANT'S SIGNATURE: TITLE <br />CONDITION(S): - 1 -7 J D� j"? <br />7720V)_-j <br />Z19 ILI) <br />_ �i 'oma u- �- s-� `, t`/li►,�ri �.c, <br />�S_ h e <br />EH 23 046 (Revised 9i/96) �� �„�,� q r .> Pag7"'� �i © `7 <br />/13' <br />