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APPLICATION FOR PER' T SAN JOAQUIN LOCAL EALTH DISTRICT <br /> UNDERGROUND TANK - 1601 E HAZELTON A:c. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone (209 ) 460-3420 <br /> IFFLICITION lot PIWlDl11/Tp(POtIRT CLOSURE OR IIIIDOINIIT 11 PLICI Of UNDRIGROUND 11111DOUS SUIS111CIS STORIGE IICILIII <br /> TRIS PERMIT 111,1111 11 DAYS 1101 III APPROVAL DITI. 00 IDT IRITI 11 111 31/DIA 1IR13. 11DICITI PERMIT TIPS SELOW: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT Randy Thomas PHONE N 209 / 948-1814 <br /> A <br /> Cort NAME Port of Stockton ADDRESS <br /> I Food Dist . Inc . 1950 E . Miner <br /> L CROSS STREET ' A ' PHONE !{20� 948- 1814 <br /> I <br /> T OWNER Port of Stockton Food PHONE M 209/ 948- 1814 <br /> Y Dist . Inc . <br /> C CONTRACTOR NAME Oil Equipment Servic ' PHONE M 209/ 754- 1808 <br /> 0 <br /> N CONTRACTOR ADDRESSPO Box 950 , San Andreas ,CA 95249 CA LIC M 323417 <br /> T <br /> R LIC CLASSA-Haz , C6140 WORK. COMP. / 265057 INSURER State Comp <br /> A Ins . Fund <br /> C FIRE DISTRICT Stockton PERMIT M <br /> T <br /> 0 LABORATORY NAME GeoAnalytical Labs . I cFHONE N 20� 572-0900 <br /> R <br /> SAMPLERS NAME Condor Earth SAMPLING METHOD <br /> Technologies Inc . Per LUFT Manual <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID 1 CURRENTLY PREVIOUSLY <br /> E <br /> M 2000 Diesel <br /> -TO— <br /> C C TO <br /> A TO TO <br /> L LIS ANY EXTRA TANKS ON A SEPERATE SH ET <br /> , <br /> P _ <br /> L (SEE A TAC KENT WIT CONDITIONS) <br /> A PLAN REVIEWERS NAMEr_ d y <br /> N DATE <br /> APPLICANT MUST PERFORM ILL LORI 11 ICCOIDANCt IIT1 Six JO/011!1 COUNTY ORDININCIS, STATE LIES, AND RULES IND RICULIrIOIS <br /> OF TRI III JO10UIN LOCAL IIILTI DISTIICT. OFFER OR L1CINSED ICI11'S SIGIITORR C111IIIL5 TIR yDLLO►IIG: 'I CIRt111 TR/T <br /> 11 TRE PIRFOININCE OF TEE TORI FOR FEICE fill PIRMII 11 ISSUED, I SIALL LOT EMPLOY IIT PIRSOE if SUCI MIMMEE IS TO BECOME <br /> SUBJECT TO FORINII'S COMPIIS1TI01 LITS 0► CALIPOR11/.' C01111CTOR'S BEING OR 191-CONTRICTING SIGIATUIE CERTIFIES ARE <br /> /OLLOIIIC: 11 CiRT1lY Tilt II TIS PItIDRMINCI 0► fit IOIE FOR IIIC1 TY1S PERMIT IS ISSUED, I S11LL EMPLOY PIRSOIS SUSJICI <br /> TO 10111111'1 COMP11111101 LIFE OF CIlI►OSU/. C001,11E HIRING ON ATT/CNSD PLOT PLII suit. <br /> CALL F9$ ARY INSPECTIONS <br /> / f �l!�1l!ATT LEAST 488 HOURS IN ADVANCE <br /> SIGNED X �I y7�l �i o TITLE• !% zo;Z —z DATE <br /> ACCEPTED BY TITLE: DATE: <br /> Rbru.TTbuI IECKIVED BY I i � � <br />