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Ntk trR tt.Nftl:tt.tnt,ttt.n.an.tTatyn:aff.NvffttlytvR.R:R:ftfttCtill: <br /> APPLICITION FOR PERNIT k: SIN JOIOU[N LOCAL HEALTH DIStIICTk: <br /> t: UNDERGROUND TAN[ k 1601 E HAIELTOM AVB., STOCKTON Cit: <br /> C CLOSURE OR ABANDONMENT t: Telephone (2091 468-3420 k <br /> t tt tt tt'tt tt N tt tt kt ttt Wt tt tt kt tt kt kt tT L't�tt tt'R41 tt-11 1:R 1 1 ty It:ff <br /> APPLICATION FOR PBRHANENT/TIMPORART CLOSURE OR ABANDONMENT IM PLACE OF UNDERGROUND HIYIIDOUS SUBSTANCES STORAGE FACILITY ' <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT 1111E 1N 111 SHADID AREAS. INDICATE PERMIT TYPE IBLOW: <br /> X REMOVAL -- TEMPORARY CLOSURE — ABANDONMENT IN PLACE <br /> IPI SITE I ; G b0 PROJECT CONTACT I TELEPHONE I Spence Poore <br /> F FACILITY NINE East Ba Municipal Utilit Di NOME I <br /> A Y P Y (209) 4_63-_246_3 <br /> C ADDRESS West Main Street Stockton, CA ' <br /> L CROSS Stilly Los Angeles <br /> T OYNII/OPERATOR PHONE I <br /> T S ence Poore (209) 463-2463 <br /> C COITIICTOR TAME Cottle Engineering PHONE 1 ( 415) 754-9935 <br /> 0 _ <br /> I COITIICTOR ADDRESS P.O. Box 163 Antioch, CA CA LIC 1 481444 CLASS A <br /> T -_ N <br /> m <br /> R IISURBI Fairmont Insurance YORK,COMP.ITransaerica Workers' omp. <br /> C FIRE DISTRICT Stockton Fire — I PERMIT 1111SPIR #12829 — — <br /> t <br /> 0 LABORATORY "MB ( <br /> Trace <br /> I PHONE 1 (415) 783-6960 <br /> SIMPLIIG FIRM' Trace Analysis SAMPLING METNODone at each end of tank <br /> t>odNYYII1NtlM�4YYMATYUNY --- -- —___--_-- <br /> ?AN[ [D 1 ?III SIII CHEMICALS STORED CL'RRENTL CHEMICALS STORED PRI'IIOUSL <br /> y <br /> )1_ 0-3 <br /> 1 <br /> _!1 s 00 — un-l-eadedasoli a --- <br /> — <br /> I ]f -1,000 diesel <br /> ]f <br /> LIST ADDITIONAL YANK INFORMATION AS NEEDED ON SEPARITB FORK <br /> YWYWYDYYtlYYYYYWp1YYtlDtlLtlY. IYM1itlDDlgtlrJLtiYNIIYIMtlIGYIDItSDtIIN9GWWAlIYWY4IUYVVYRDtHIJItlIJIJYMILVYYY7`JN1L'YFuC!OPCIIIYHICIIYJYIL„YVWYWIWMiWIp19MdDIIWWNUIDNIdtlhTllilYlYIwWIWYYNIWR , <br /> P - APPROVED _APPROVED WITH CONDITIONS DISAPPROVED <br /> L SIE ATTACHMIMT WITH COHDITIOVSI <br /> A PLAN REVIEV913 NIMB <br /> WIMYAUR1tlYgINIMNVYq�Y�YRYJI <br /> APPLICANT MUST PERFORM ILL YORK 11 ACCORDANCE BITE SAN JOIOUIN COUNTY ORDINANCES, STATE LIPS, AND RULES AND REGULATIONS <br /> OF THE SIN JOAOUIY LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CERTIFY THAT <br /> 11 TNR PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I S41LL WOT EMPLOY ANY PERSON IN SUCH MANNER IS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LIPS OF CILIFORWIA.' CORTRICIOI'S HIRING OR SUBCONTRACIIWG SIGNATURE CERTIFIES THE <br /> FOLLOVINC: Of CERTIFY ?NIT IM THE PERVORMINCI OF THE WOR[ FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUOJFC <br /> TO YORKER'S COMPEWSITION LABS OF CILIFORY[1. <br /> CALL FOR INSPECTIONS AT LE T 40 HOURS IN ADVANCE <br /> dL <br /> SIGNED /�-E7a�� �E� ---- ----- DATP.- _�---- <br /> OFF[CB USK ONLY-811 2 046 r12/81 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSFSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSs'SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS!SSSS <br /> SVBEPS I I COMP I ILOC CODE IDIST CODE AMOUNT OUR I AMOUNT RCVD I CXI/CISU I RCTO By I DATE HCVD PERMIT I <br />