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ttn1:t1ttoRtit:ti:ffRt;ttatLt.ttMI:cetot;tt 1tt rmgw ttn <br /> APPLE FOR PERMIT t: SAN JOAQUIN LOCAL f 11WRIC����t�y� l/ <br /> t UIDRRGROUND TANK G 1601 B HAIELTOM AVB., STOCKTON C <br /> t CLOSURE OR ABANDONMENT t: Telephone (1091 1A0-3120 <br /> fit:R:ft:t1toti:RttttR tototxRR .ti:RttRtotkRtoR:ft tt11it:Rtotot1 FEB 0 1990 <br /> APPLICATION FOR PRRMANBNT/TEMPORARI CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUID RdZIRDOUf 0giI9GQANQ¢S "aT01<dG�FdCILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM INS APPROVAL DATE. DO NOT IRATE IN 111 Sum A.REIS. INDICATE I'MIT TYPE B¢LOY: <br /> 't/REMOVAL TEMPORARY CLOSURE _ IBAYDONNEIT IN PLACE <br /> EPA SITE IC �9 7 PROJECT CONTACT d TELEPIONE I G ee�&- ' <br /> r �- <br /> F FACILITY NAME , c YJLGC PHONE 1 aD y -33 7Y <br /> I <br /> ADDRESS <br /> I / t 1 (> Q L C <br /> L CROSS STRAIT <br /> 1 14 u9 ` 3 <br /> T OWNER/OPBHATOB PHONE I <br /> 1 <br /> C CONTRACTOR NINE G ep t ; PHONE 1 9 �3 J 3 J <br /> 0 <br /> I COYTRACtOB ADDBBSS u r1.A M Fcrr 1Z�L CA , Cd LIC I CLASS <br /> T <br /> I INSURER I1.4/J0V :5 IORK.CONP.1 3191S6 <br /> C FIRE DISTRICTr r A L PERMIT 1/IMSPT9 _ 6 <br /> f <br /> 0 LABORATORY YANG FG L 4oeq-1I T)C4 C PHONE I g I <br /> R <br /> SAMPLING FIRMS r G L N 9 L aT!Lhl L SINPLING HETIOD S6 t <br /> TANK ID I TAXI SIZE CHEMICALS STOiZD CURREITLI CHEMICALS STORED PRIVIOUSL <br /> 1 <br /> i 1 39- K e e ep <br /> 5 Y 39 :�— .SCS d a SElf CL <br /> 39- — <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED 01 SEPARATE FORK <br /> 1Ytl108YNIYWNIINYINIYIYIWWIIRRtlYININYWIYNtl 4lgtlNglNBltltltl I4B0931m RIYWtUVWLBtldttlWlYNmCNYUI�J tRl�ttrBY9WNWNOIWUGW101WCWJY9IWtlR6INaY810NNtldIYIItlVG <br /> P _— IPPROV¢ PROVED WITH CONDITIONS _ DISAPPROVED <br /> L (S BATT C T V1TN COXDlfICY1) ) <br /> A PLAN RBP[IYBRS NANB _ N/1� DATE �' / -7 O <br /> 1 <br /> 1N1Y M <br /> APPLICANT MUST PERFORM ALL WORK 11 ACCORDANCE WITH SIN JOIOUIN COUNTY ORDINANCES, STATE LAYS, AND RULES IND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> 11 THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SMALL NOT EMPLOY ANY PERSON IN SUCH HAMMER AS TO BECON <br /> SUBJECT TO YORKER'S COMPENSATION LIVS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SLINITRACTING SIGNATURE CERTIFIES INS <br /> FOLLOWING: 01 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL EMPLOY PERSONS SUBJEC <br /> TO YORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 40 HOURS IN ADVANCE <br /> SIGNED DATE <br /> OFFICE USE ONLY--811 23 016 12/01 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS <br /> SWEEPS I ( COMP I- ILOC CODE DIST CODE] AMOUNT OUR AMOUNT RCVD _ CKIICASEBY 001 RCVD PERMIT I <br />