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APPLICATION FOR PERM SAN JOAQUIN LOCAL FALTH DISTRICT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone ( 209 ) 468-3420 �A <br /> APPLICATION FOR PERNANENTITEXPORIRY CLOSURE OR 18110ONMENT IN PLACE OF UNDERGROUND HASIRDOUS SfiSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE IPPR09IL DATE. DO NOT WRITE IN ANY SHADED ARE1S. INDICATE PERMIT TYPE BELOW: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT �HONE # 20°) 9�-�-p24'� - -- <br /> a Ii OZ_�1111 .—...—.—._--.—_ <br /> A ---- a�111r a oc t4n <br /> C FACILITY NAME ADD1�S,.a. Washington St, Stockton, Ca. <br /> I Cal AIIMonia _ _ _ -_ ____.._ —....__----._____._�___ ..—.._.._. <br /> L CROSS STREET Dort of Stockton - -.PHONE 20 )/ 9p,,6_0246 <br /> I aad 1 Road 0 <br /> T OWNER Cal Ammonia PHONE # L2D9� 466. 9957 <br /> Y 2201 W. Washi-ngt0n Stree-� Stockton <br /> C CONTRACTOR NAME;earth Cal Construction <br /> PHONE « <br /> O - <br /> N CONTRACTOR ADDRESS CA LIC # 50570 . <br /> i. ,ox 588 Stockton, Ca. <br /> T <br /> R LIC CLASS WORK . COMP . # CS 400-Z}997 INS[ strial Inder;nj��r <br /> C FIRE -DISTRICT Coli 1 l - 1701 Nest Washingtoll PERMIT # <br /> --[ <br /> 0 LABORATORY NAMEPHONE # (,�,�,../ <br /> 366-1701 <br /> JR H. Kleinfeld�,r �..—.-. _---.-- <br /> SAMPLEI7S NAME ..c�;.r€� at this tis a SAMPLING METHOD Brass Tubes <br /> CT VOLUME CHEMICALS STORED— DATES STORED- CHEMICALS STORED <br /> H ID # CURRENTLY PREVIOUSLY <br /> M �� 20 000 c., j� ---_ .-_-- 7i TO 1tot8 Diesel <br /> 20 my ATOo—ov'��" <br /> C TO <br /> A TO <br /> L LIST ANY EXTRA TANKS ON A SEPERATE SHEET <br /> I`mmumi <br /> b l <br /> P — <br /> L ( EE ATTACHMENT I GC3ND IONS) — Ci ' <br /> A 'PLAN REVIEWERS NAME DATE f (} <br /> IPPLICINT MUST PERFORM ALL FORK IN ICCORDINCE WITH SAN JOIQUIN COUNTY ORD[WINCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SIN JOIOUIN LOCAL REILTH DISTRICT. OWNER OR LICENSED IG1171S SIGYITURE CERTIFIES TBE FOLLOWING: 'I CERTIFY THAT <br /> IN TEE PERFORMANCE OF THE FORK FOR WNICH THIS PERMIT IS ISSUED, I BRILL NOT EMPLOY III PERSON IN SUCH MANNER IS TO BECOME <br /> SUBJECT TO WORIMIN'S COMPENSATION LIWS OF CILIFORNII.' CONTRICTOR'S HIRING OR BUI-CONTRICTING SIGNITURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORNINCE OF THE WORK FOR WHICH TRIS PERMIT IS ISSUED, I BRILL EMPLOY PERSONS SUBJECT <br /> TO WORIMIN'S COMPENSITION LAWS OF CALIFORNIA. CONPLETE DRIVING ON ITTICHED PLOT PLAN SHEET. <br /> GALL FOR ALL NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SIGNED X �' TITLE: DATE: <br /> ACCEPTED BY TITLE: DATE: <br /> own <br /> I <br />