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e tt tt'tt tt tt c� } °t et ett tt tt tt tt c et tt et tt tt tt c t tt tt tx tt tl tt r t: tv <br />t APPLICATIG,.JR PEkMIT t SAN JOAQUIN LOCAL HEALTH DIS.-.iT <br />UNDERGROUND TANK <br />t t 1601 E HAlELTON AVE., STOCKTON CA <br />t: CLOSURE OR ABANDONMENT t; Telephone (209) 468-3420D <br />�: n .x .a: ►a fix: � �: ►x n: ►x n�: ►a: ��: n: Via: a ►a: ►a: �x Via: u: ►a: n: ►a: ��: ►�: n: Via: n: �x ► io7 � O <br />APPLICATION FOR PERMANENT/ TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZAR GUS MMRAES�S� E FACILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PENT' TYPELOW: <br />XX REMOVAL ----- TEMPORARY CLOSURE ___- ABANDONMENT IN PLACEPIERNENTAL <br />MIT / SERVICES HEALTH <br />EPA SITE ICAC 000158517 PROJECT CONTACT 6 TELEPHONE 1 <br />( 209) 462-4 581 <br />F FACILITY NAME Lodi Ready Mix <br />PHONE 1 (209) 368-2794 <br />A <br />C ADDRESS 851 E. Lodi Avenue, Lodi, CA <br />L CROSS STREET Beckman Road�- <br />I <br />T OWNER/OPERATOR Bob Spoor <br />PHONE 1 (209) 368-2794 <br />Y <br />C CONTRACTOR NAME ,JIM THORPE OIL, INC. <br />PHONE 1 (209) 462-4581 <br />0 <br />N CONTRACTOR ADDRESS 351 N. Beckman Road <br />CA LIC 1 495699 <br />CLASS A, Haz <br />T - <br />- <br />R INSURER on file WORK.COMPA on file <br />A___-____—.- ---____.__-.-------__.__...-•--.--.--.-____------.._.___....__-___._______Y—_---.----..__.--------.._—. <br />C FIRE DISTRICT L od iPERMIT 1/INSPTR <br />l� <br />T — -__-__ .--E— <br />0 LABORATORY NAME Canonie Environmental �PHDNE <br />-�— <br />1 (209) 983-1340 <br />R <br />- <br />SAMPLING FIRM# same SAMPLING METHOD Brass Tube - See #5 on removal <br />TANK 10 1 TANK SIZE CHEMICALS STORED CURRENTLYCHEMICALS STORED PREVIOUSI <br />T <br />1,000 Unleaded gas <br />N 39-3--�-0 Z 1 000 Diesel <br />_/ -------------------- <br />_ _ <br />K 39- <br />39- <br />39--------------------------- — -- - -- <br />LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br />P _�_ APPROVED _ APPROVED WITH CONDITIONS DISAPPROVED <br />L(SEE ATTACHMENT WITH CONDITIONS) I <br />A PLAN REVIEWERS NAME ------------------------------------------- DATE `�l/�L--------- <br />t <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br />OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT <br />IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br />FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, l SHALL EMPLOY PERSONS SUBJEC <br />TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br />CALL - C QmS AT LEAST 48 HOURS IN ADVANCE <br />SIGNED - �� 6, �[��_ _(_Vice -President 3/16/89 <br />-- - -- - ----- ------------------------------- <br />_______DATE ------------- <br />-------------- S 0 IY--EN 23 0A 11/88 <br />$$$ ff ff fffffffffffffffffffffffffffff fffffffftffffffffffffflffffififfffffffffffiffiffffffffffffffffff$$$$$$fffffff <br />SWEEPS 1 I OMP 1 LOC CODE I DIST CODE AMOUNT DUE I A0OO4NT RCVD I �Y.JfM ?D BY �RID PERMIT I <br />plan <br />