Laserfiche WebLink
t ti ti tic ti ti ti"ti ti' i t i tt'ti:III:ti:ti'ti't`:ti:ti'ti:ti'111:R:ti:ti:ffti ti ti:III:ti ti jj TT <br /> APPLICATION FOR P MIT SAM JOAQUIN LOCAL HEALTH Of SIR ICT <br /> a��! t UIDERGROUND 1. K t: 1601 B HAIELTON AVB., STOCKTON Cit: <br /> t: CLOSURE OR 11111011117 t: Telephone (2091 168 3121 t _ <br /> / t 11:t1 ti t1 t1 t1:t1 ti k1 tIrt1 ti ti'ti t1:ti ti ti ti t1 ti't1 ti ti ti ti ti ti:t1 t1:t1:t1 1 1991 <br /> APPLICATION FOR PBRMAHEIIT/TBMPORIRT CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND RAIIRDOUS SUBSTANCES <br /> �G FA kfT t <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVIL DATE. DO NOT 11178 IN III SHADID AREAS. NDICAfiN III <br /> —— _ RBNOYAL --_ TEMPORARY CLOSURE ^ ABANDONMENT IN PLICI <br /> EPA SITE I PROJECT CONTACT i TELEPHONE IRc <br /> F FACILITY NAME Cj��CL(<S� /�+✓ ���t rlp�� PHONE I (Jct <br /> C IDDRESS 4315 wA -2t_C�C� �1J S >' ►�► GA 5Zv_; <br /> I <br /> L CROSS STREIT (61-TE5b <br /> T OWNER/OPERATOR PHONE <br /> T �l�t-�-lar� I�cxzgY (�)y ��►- 3��4 <br /> -C CONTRACTOR NIMB ^' \ �:--:-----:-`-~--_.�-_-- <br /> i_rr� �Yae�l PHONE 101-s 1 163- Isoo <br /> 0 _ <br /> I CONTRICTOR ADDRESS IC)92_ d&Tr_> ,/,,'L CI LIC I CLASS <br /> R INSURER YORK,COMP.1 <br /> C FIRE DISTRICT <br /> PERMIT I/INSPTR <br /> 0 LABORATORY NIMB110[.�IG L,a.C3S PHONE I C ) 9a3 <br /> R ---- <br /> 3AMPL(IC FIRM' 1.1.�vIRCNeIJTAI– SAMPLING METIOD <br /> - NQYTIYIVYlWQWWIINWIIQQQHQIAlI1NWWtlVINQI QNHQI1RiQ1Q1 ---- <br /> TANK ID I TAIK SITE CHEMICALS STORED CURRENTL CHEMICALS STORED PREVIOUSL <br /> 1 S cx�c> C ^L . <br /> N 39------ 6-1- rt litil = Sr�f�ti <br /> K 39---- --- _ Kc n.� i --- <br /> 39 _ __ — <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED OI SEPAR119 FORM <br /> VIlIIQQIWIIIIQtIRNQQIIVIgWIYiNNIIIllQI�IIVIWQHIVWQVq}VVQNQYIQI 119dIIIQUIflIiQWWIIlII111QVIUUIVIIVIVQIIlU9li!QUIr'lI1VllRQII�IRRIQ`�VIQ!JIQWIlr7VII8QIVVV9"SCI'�illRllJ1:�11i�VlIIVIIIQYtY�IVrQIHVV6IUCIIQIIHIQIWIQtlV;IIQDllIRIIQ!IICWIu1QJIQiVIIIINIIQIRQIVW <br /> P __ IPPROVED _ IPPROVBD WITH CONDITIONS __ DISAPPROVED <br /> L (SEB ATTACHMENT WITH COHDITIOWS) <br /> A PLAN REVIEWERS NAME —_ <br /> -- MIV@I�1Nq�N�1 1 lIYRIIQN{�INQ�VkXlW�IQIV✓yYJp RIYQIQWIYYQI�IKIIIRIRXINNV1ftliQ1 <br /> APPLICANT MUST PERFORM ALL YORK 11 ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES IND REGULIfIOHS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT, OWNER OR LICENSED IGENT'S SIGNATURE CERTIFIES THE FOLLOW[NC: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IM SUCH MANNER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAYS OF CALIFORNIA,' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY THIT IN THE PERFORMANCE OF THE PORI FOR WHICH THIS PERMIT 13 ISSUED, I SHALL EMPLOY PERSONS SUOJEC <br /> TO YORKER'S COMPENSATION LIVS OF CALIFORNIA. <br /> CALF FOR INSPECTIONS AT LEAST 40 [LOURS IN ADVANCE <br /> OFFICE US ONLY-- 11 13 016 1 /dt ---- <br /> S$SS$SSSSSS $$$$$$$$$$$$$$$�$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$S$$$$$$$$$$$S$$SSS$ $$$S$SSSSSSS$SSSS$SSSS$SSS$SS$$SSS$SSSSSS <br /> SWEEPS ( � COMP I <br /> I <br /> LOC CODE( DIST CODE A""NT DUE I AMOUNT RCVD I CKI/CASI! RCYD DATE RCVD PERMIT 1 <br />