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,54" Soa Qul r� <br /> UNDERGROUND TAN II 1601 E HAZELTON , STOCK-TON CA +� <br /> J� CLOSURE OR ABANDONMENT- �— -Telephone ( 209 ) 468-3428 a <br /> APPLICITION FOR PERMANENTITEMPORARI CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND RIEIRDOUS SUBSTINCBS STORAGE FACILITY <br /> TRIS PERMIT SIPIRES 90 DAIS FROM THE APPROVAL OATS. DO NOT YR1TS 11 111 SRIDED AREAS. INDICA?$ PERMIT 'LIPS BELOT: <br /> REMO" AL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACTPHONE # -�,Y <br /> C FACILITY N ME ADDRESS <br /> L OWNERADDRESSr LS (r� ADDRESS <br /> i I C—_.__ �._ _ a <br /> T CROSS STREE PHONE # �f <br /> + y -- <br /> C CONTRACTOR NAME FcL <br /> N CONTRACTOR ADDRESS CA LIC # <br /> R LIC CRASS WORK . COMP . # INSURER <br /> C{Ut pyo d scs7-� . <br /> C FIRE DISTRICT PERMIT # <br /> T Sci[(ct�`@r _ Fe Prc. i si <br /> 0 LABORATORY NAME PHONE # �f <br /> R — af- ( U 8s <br /> SAMPLERS NAMESAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID # CURRENTLY PREVIOUSLY <br /> E <br /> M 1 UrPc�C_Qcoo —To- <br /> !2, <br /> O <br /> I Do t7 tPSC TO <br /> C TO <br /> A TO <br /> L LISt ANY EXTRA TANKS ON A SEPERATE SH ET <br /> P <br /> L (SEE ATTACHMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME 7 I4 r ml= j ! v" c DATE 7- I e- k... <br /> 71�- <br /> [[-N <br /> APPLICANT MUST PERFORM ALL YORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDININCES, STATE LAYS, 110 RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGYITURE CERTIFIES THR FOLLOWING: 'I CERTIFY 791T <br /> IN THE PERFORKIYCE'OF THE YORK FOR YHICH THIS PERMIT IS ISSUED, I SKILL NOT ENPLOY 191 PERSON IR SUCK MANNER IS TO BECOME <br /> SUBJECT TO WORKMAN'S COMPENSATION LAYS OF CALIFORNIA., CONTRACTOR'S HIRING OR SUB-CONTRICI NG SIGNITURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY THAT IN THE PERFORMANCE OF THE YORK FOR YRICH THIS PERMIT IS ISSUED, I SHILL EMPLOY PERSONS SUBJECT <br /> TO WORKMAN'S COMPENSATION LAYS OF CALIFORNII. COMPLETE DRAWING Of ATPACIED PLOT PLAN SHEET. <br /> CALL FOR ALL NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SIGNED X TITLE : DATE: <br /> ACCEPTED BY TITLE: DATE: <br /> lwm Igo Oil 11 <br /> 7 , <br /> N -dflRli�il � <br /> tliYAflAlllllul�q,'yAIAA3AIABIAAIAIIAIAAVpHIAAAiNAAIANIYAI�NpIH14A@AIAIAIIEfAIIAIHyIiAliWir�IARA{If1AAlAGAI�IIAAAlAl1�1111AtIICIAIII!AIIAIRfIiIllAlpfgA� IIIHI[i�19YU! �INIAINAIAIIGIAA <br />