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t tit t&4141!ft tit R:t11 tlrfttyaaati.,kttl:n:tvtrtnl: <br /> r APPLICATIOM FOR PERMIT t: $11 JOAQUIN LOCAL HEALTH DISTRICTj: <br /> t; UNDIRCROUND TANK t: 1601 B HIIRLTON AVE, STOCKTON Cit: <br /> CLOSURE OR IIINDONMSNT t: TeItPhOAe (209) 461-3420 t: <br /> t'fftt:ttlfR414141'3'tti'ti tt:ti:ti:ti11:fttit:ti:3:ti:tt-'fttt,ti:ti ti R 1:tt,tt:R:. <br /> APPLICATION FOR PERMANENT/TSMPORIRY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HIIIRDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT RIPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT 11179 IN III 3111DI0 AREAS. INDICATE PERMIT TYPE IRLOH: <br /> X RINOYAL --- TEMPORARY CLOSURE ABANDONMENT IN PLICE <br /> EPA SITS I C A C 0 0 0 5 5 9 1 7 6 —�PROJ9CT CONTACT i TELEPHONE K e i t h A . T a 11 i s <br /> 209-7 <br /> F FICILITI NAME Sullivan & Mann Lumder Co . PHONE I <br /> I 209-858-4737 <br /> iDDRES9 16177 So . McKinley <br /> L CROSS Still? L o u i s e Ave <br /> I <br /> 1 OMNER/OPBRATOR <br /> PHONE I <br /> T Morton Sullivan <br /> 209-223- 1676 <br /> C CONTRACTOR MAMM C i l E g u i p m o n t S e r v i c e PHONE I � <br /> 0 209-754- 1808 <br /> I CONTRACTOR ADDRESS F0 g o x 950 CA LIC I CLASS <br /> T 323417 A , Haz <br /> R INSURER State Compensation Insurance Fund YORK.COMP.1 <br /> 1 _ _ 265057 <br /> C FIRE DISTRICT City of Lathrop PERMIT I/IMSPTR <br /> t <br /> 0 LIBORITORY NAME PHONE <br /> R GeoAnalytical Labs Inc . 209-572-0900 <br /> SAMPLING FIRM= SAMPLCIG METHOD <br /> th Technologies <br /> III( ID I ILK( SIZE CIIEMICILS STORED CURRINYLI CHEMICALS STORED PRNVIOUSL <br /> T <br /> Y 3!• 1800 -Wash water from aint qun <br /> was nut into thi tank and <br /> ?!• allowed to eva a ate . <br /> 3!- <br /> LIST ADDITIONAL TANK IMFORHATIOY AS NEEDID ON SEPARAT9 FOR, <br /> uuu+u�u�uul ++wwu�wu�u�uuuu�+uvuvl�u+�ulu �u�w���u�,u�� uuuw��uuu�u��;��uu�uw�u��u �u.u��uu�ua�uw��uuw�uu�uwu+tu+�w�+r�uu �u�uuu�uu�uu <br /> P '1�PROWED _APPROVED WITH CONDITIOAS DISAPPROVED <br /> L ISIS ITTACUNEYT WITH COd011101S)� <br /> 1 PI,11 RE9IENERS M1M9 <br /> �WtWiRYINIYWiI <br /> APPLICANT MUST PERFORM ILL MORK 11 ACCORDANCE WITH SAN JOIQUIN COUNTY ORDINANCES, STATE LIES, 110 RULES IND REGULATIONS <br /> OF THE SIN JOAQUIN LOCAL HEALTH DISTRICT. ONMER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> 11 THE PERFORMANCE OF THE WORK FOR VHICN THIS PERMIT IS ISSUED, I SMALL NOT EMPLOY ANY PERSON 11 SUCH MANNER 13 TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAWS OF CALIFORNIA., CONTRACTOR'S HIRING OR SUfCONTR1CfIYG SIGNATURE CERTIFIES THE <br /> TO YORKER'S COMPENSATION LAYS OF CALIFORNIA.I <br /> FOLLOWING: '1 CERTIFY NiIN THE FORNOF TITS WORK FOR WHICH THIS PERMIT 11 ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> L <br /> CALL Pq.R 1 N > TIO A _L13AST 40 1.10URc; <br /> IN ADVANCE <br /> SIGNED <br /> OFFICE USE OILY—I&2314f 12/11 KEITH A . TALLIA - --�'" DATE 2/ 1 /91 <br /> SSSSSSSSSSSSSSSSSSSSSSSSS$SSSSSSSSSSSSSS$SSS$SSSSSSSSSSSSSSSSSS$SSSSSSSSSSSSS$$$$SSSSS$S$$SSSSSSSSSSSSSSSSSSS$SSSSSS$SS$S <br /> -- <br /> SWEEPS I I COMP i LOC CODE DIST COD IMOUIIT_DUE UUMf.f�CVD_ <br /> 159 01,TSB DATE RCVD PERMIT ! <br /> _�_-. 2 , <br /> .1_ <br />