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i <br /> ` a <br /> SAN JOAQUIN COUN'T'Y PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE. TAMC CLOSURE PERhIIT <br /> THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN 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 Silt N � PROJECT CONTACT i TELEPHONE N dim Thorpe OU , Inc. (209) 368-6175 <br /> f FAC I L I TY NAME Connel l Motor Truck.Co. , I nc. PHONE N (209)466-2411 <br /> A <br /> C ADDRESS 2211 N. Wilson Way, Stockton, CA 95205 <br /> 1 <br /> L CROSS STREET Bradford St. <br /> I <br /> T OWNER/OPERATOR Same as above PHONE y <br /> Y (209)466-2411 <br /> C CONTRACTOR NAME dim Thorpe Oi 1 , •Inc. PHONE N (209) 358-6175 <br /> 0 <br /> N CONTRACTOR ADDRESS P. 0. Box 357, Lodi , CA 95241 CA LIC X 495699 CLASS A, B, Haz. <br /> T <br /> R INSURER Flreman5 Fund/Genstar WORK.COMP.lA 007197-9$ <br /> APERMIT # <br /> C FIRE DISTRICT The City of Stockton U n A,=Qmi <br /> T <br /> 0 LABORATORY NAME,GeoAnalytical Labs COUNTY San Joaquin PHONE II (209) 512-0900 <br /> R PHONE M 209 572-0900 <br /> SAMPLING FIRM pp�� 1 1Cdl Laboratories { ) <br /> IIIIIIIIII1111lll� �ll1 1r�11 <br /> TANK ID TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> 39_ 0044 1.0,000 gallons diese1 fuel <br /> T 39- 13 145,11-- <br /> A 39 i r)'f — a Q <br /> 11/86 <br /> N 39- <br /> K 39- <br /> 39- <br /> 1111[i111TfMT 41T111UrTTT U I1ITITTT I IiTRiT fi l <br /> P <br /> L APPROVEDAPPROVED WITH CONDITIONS) DISAPPROVED <br /> A ( EE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> N PLAN REVIEWER'S HAMS ' DATE <br /> f <br /> — 1111111111111111111111111111111111111111111111111111i11 III IIIIUIIIIIIIIIIIIIIIIIIUIIIIIIIIIIIIIilllllllllllllllllllllllll <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 FOLLOWIN03 "I CERTIFY THAT IN <br /> THE PERFORMANCE OF THE 'WORK FOR WHICH THIS PERMIT IS ISSUED, 1 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 FOLLOWIN0 <br /> "T CERTIFY THAT IN THE PERFOR E OF THE WORK FOR WHIG THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OP CALIF A." <br /> APPLICANT'! S10NATUREi ITLE Contractor/Agent DATE 4/22/98 <br /> CONDITION(S)T <br /> mss° '7� `cam <br /> IN 23 046 (Rtv(19 9/11 96) Page 3 <br />