Laserfiche WebLink
+ APPLICATION FOR PEE SAN JOAQUIN LOCA LTH DISTRICT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone ( 209 ) 468-3420 <br /> "APPLICATION FOR PRRMANIIT/TEMPORIIT CLOSURE 01 1811DOIKENT 11 PLACE Of UIDBIGIOUID I1t1ID09S SUBSTANCES STORAGE FACILITT <br /> TE <br /> IT BIPIRRS TR DAIS 1101 Tit 1PPIOTIL DATA. DO 10? IIHI II 111 SKIDII AREAS. INDICITI PRINT TTPI BBLOI: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT PHONE #,�f <br /> A <br /> — <br /> C FACILITY NAME �89 <br /> ADDRES£ �� <br /> L CROSS STREET ��� `�'r PHONE N-9�_ '�,7.?K� <br /> I <br /> T OWNER PHONE I <br /> Y11 <br /> C CONTRACTOR NAME S'E>lIIOLL� PHONE <br /> 0 <br /> N CONTRACTOR ADDRESS,,57-7 CA LIC N¢27'_7zJQ <br /> T <br /> R LIC CLASS 16,7 WORK . COMP. N S�'� INSURER <br /> A <br /> C FIRE DISTRICT �i.Y>'6Ae7/�Z7 PERMIT N <br /> 0 LABORATORY NAME ,�',yO4�Z PHONE N- � <br /> R <br /> SAMPLERS NAME SAMPLING METHOD Ge yZ,4VZ�E <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID N CURRENTLY PREVIOUSLY <br /> E <br /> M TO �'ZF'0&1 .�J <br /> I fc?Z? TO <br /> C TO _ <br /> A l'>v TO /&S7E :Z <br /> L —LI-StANY EXTRA TANKS ON A SEPERATE SH ET <br /> P <br /> L (SEE ATTACHMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME DATE <br /> N <br /> APPLICANT MUS? PERFORM ILL LORI 11 ACCORDANCE RITE SAN JOIOUII COUITT ORDIIINCIS, STITK LARS, AND RULIS AND RBGULITIOIS <br /> OF THE 311 JOI0UII LOCAL IIALTt DISTRICT. DINER OR LICENSED 1C111'$ SIGIITORE C1111FIES HR FOLLOIIIG: 11 CERTIFT HIT <br /> II fit PERFOIMINCI OP fig TORI FOR THICK THIS PERMIT IS ISSUED, I SKILL HOT BMPLOI III PERSON 11 SUCH MANNER /S 10 BECOME <br /> SUBJECT TO IORINII'S COMPII31TIO1 L11S Of CALIP01111.' COITHOOR'S IIIING OR 101•CONtRICIING SIGNATURE CRITIFIRS THE <br /> FOLLOVIC: 11 C/2111T THAT 11 TKE PNRFOIMAICS OF 191 PORK FOR /IICN TILS PERMIT IS ISSUED, I STILL EMPLOI PARSONS SUBJECT <br /> TO IORIKII'S COMP11317101 LII$ Of CALIFORNIA. COMPLETE BRINING ON 1ffICHED PLOT PLAN Nifty. <br /> CALL FOR ALL NECE S Y INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SIGNED TITLE: �.�>'��/r�/ DATE: <br /> ACCE D B TITLE: A_-k n�/I'.I DATE: <br /> ftummmmumm— <br /> � I I I I UATSI p <br />