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i <br /> L A� PLiCATION FOR PERMIT SAN JOAQUIN LOCAL H0.ml DISTRICT <br /> 1601 E HAZELTON AVE. , STOCKTON CA <br /> UNDERGROUND TANK __ _-6--.2---- <br /> CLOSURE OR ABANDONMENT Telephone —( 209 ) 468 -3420 --J <br /> L.MP'Llemol POR PlaNINENTITIMPORIRT CLOSUil OR 18IVDONMINT 19 PLICI OF UNDIRCROUND 111tIRDOUS SUISTINCES STORIGE FICILITT <br /> THIS PE NIT SIPIRHS 10 DIPS PROM TNR IPPIOYIL Dill. DO NOT TRITE IN JIT SHIDID 1REIS. INDICITI PERMIT TYPE ORLON: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT Mf} ,10Ga� SA►�GHE� PHONE ZOq-/ `+(d _IZ�1 <br /> FACILITY NAME — ADDRESS 1B�Io CooNrey �'a,u8 <br /> ' SME <br /> i l <br /> CROSS STREET Mtotil PHONE <br /> R <br /> OWNE �( f� pml S Nmll <br /> PHONE 0 .709--/ (O'L 114 <br /> Y <br /> CONTRACTOR NAMETHagPE OjL N <br /> PHONE <br /> 0 <br /> f V CONTRACTOR ADDRESS 35'1 BeCr-mAM )Z6AJ LOO./ — CA LIC I( yci5�aq— <br /> I R LIC ,CLASS WORK . COMP . M _ _[--�ERMIT <br /> INSURER <br /> LAC FIRE DISTRICT — � <br /> T <br /> 0 LABORATORY NAME PHONE # 204 / 9B - -� `— <br /> SAMPLERS NAME SAMPLING METHOD— <br /> ` C VOLUME CHEMICALS STORED �— DATESSTOREDCHEMICALS STORED <br /> H ID lip CURRENTLY -- �-^- PREVIOUSLY <br /> E trNUE�n s I <br /> C rlrol�g —TO_ <br /> TO <br /> ! A TO <br /> LIS ANY EXTRA TANKS ON A SEPERATE SH �ET <br /> I L <br /> 9=4000� 91011 4 <br /> P N S <br /> L (SEE TTACH EN ITH CONDITIONS) <br /> 1 A PLAN REVIEWERS NAME DATE <br /> ' N ;I <br /> IPPLICINT Null PERFORM ILL YORK IN ICCORDINCI 11TN $11 JOIOUIY COUNTY ORDINANCES, ST01 LIVS, -IND RULES AYO RIGULITIONS <br /> LOF S NIIING OR TNI S1N JOIOVIN LOCIL a11LTN DISTRICT. 011111 OR LICINSFO IGIIT'S SIGIITURCTlMC H CIITIFIES TNR FOLLOYING: 11 CERTIFY ?III? <br /> IN THI PIRFORMINGI OP TRH PORI FON YVICH TEES PIRNIT 1S ISSUED, I SPILL NOT INPLOT IVYPERSON It SUCH MINNER IS TO BECOME <br /> ?UBJICT TO NORKMiV11 COMPINSlT101 L1YS OF CILIFORNII.' COYTRICTOR' Jul-coml SIGNITURI CERTIFIES 111I <br /> FOLLOVINC: 'I CIR?EFT Tull IN THH PIRFORNINCB OP 191 PORI FOR NRICH Till PERMIT IS ISSUED, I SHILL EMPLOY PERSONS SUBJECT <br /> LTO TORINil'SSCONPIN91T70Y LITS OF CILIFORVII. CONPLITI DRIVING ON 1TTICHED PLOY PLIN SNEIT. <br /> CALL FOR ALL NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE I <br /> Liy6NED X 1 TITLE: DATE : <br /> ACCEPTED"BY TITLE: DATE: <br /> 9w <br /> TN Ii��k=jl <br /> FI1 IJiiCL W.{'L1J.11•G.��L�WLIIYiWL1e111AYJI�FIIoiLlh�11Y{u LlI11L�I1.I.IlYi�LJ1tI��Y•YID+aJiialf'�I••I�,.Z��--`IIIUIp����i.III I�k IN��'1'a1LLW.iJ�IILWY.i•�G��LlIIiW'.L.a''liu_�._ <br />