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t t t�t3'rx r3 t;'tt t�r HL t tt t 17f t4 kV IV IV IV rig":ti rt tt ri M.r�IT,ri r; <br /> k, APPLICATION FOR PERMIT r Sig JOAQUIN LOCAL 1616TH DISTIICT�: <br /> e: <br /> t: UIDRRGROUND TANK. t 1111 B MItRLfON IVB., STOCKTON Cir: <br /> C CLOSURE OR 111NDONNBIT F Teleplole (209) (11-)121 t: O C T 03 �9 4 <br /> IPPLICITION FOR PRRMANBIT/TBMPORIRY CLOSU19 OR 1811DONNENT 11 PLICA OF UNDERGROUND R1111DOUS SUBS1110ES'SfOHG1 FICILITIFALT' <br /> THIS PERMIT 61PIRIS 90 DITS FROM THE APPROVAL DATE. DO NOT 11111 19 111 SIIIDKI AREAS. INDICATE PERMIT TYPE IRLOV: we <br /> _ RIMOVAL _^_ 11MPORIRT CLOSUIB IBINDONMBNT IN PLICI <br /> T <br /> BPtOJICT CONTICT A TELEPHONE (r <br /> PI SIT, LRD �5� (�� —�� — ----- <br /> P FACILITY MIME�Z <br /> b Yom` PHONE I <br /> 1 — - yfTr _ <br /> C IDDRRSS 3 1_ f\l o t ry P,l S c ��Tc,o � <br /> L CROSS ST1111 <br /> T OWNER/OPIRITOR ` PB019 <br /> 1 c <br /> C CONTRACTOR IIMji•_r c' c PRONECA(-,-k <br /> -\l �Gf'Ptti e/U� . _ F-tl ��-� <br /> 0 �)` <br /> 1 CONTRACTOR IDDRBS CI LIC I cI C, C6ytS� <br /> VORK.COMP.1 <br /> _� --- <br /> C PARE DIST11T, -Icj <br /> PBRNIT I/INSPTR <br /> I <br /> 0 LIBORITOIT NIMB .� �Q1 1� �'lNE fZ PNOIB tetl <br /> SIMPLING PIRV t{ rti.,c 1, F{ E,_f� N� SAMPLING MEt10D --- <br /> - bNYpYlre - <br /> TANI ID I TIKK SI111 CHEMICILS STORED CURRENTLI CHEMICILS STORED PRIVIOUSL <br /> (,_�f�S �L <br /> o CSC �C — <br /> )9- <br /> __ —'— LIST IDOIT[OIIL TINK INFORMATION IS NBEDRD ON SEPARITR PORN <br /> YNMIIgIMWIalYYWIIIYUNIIWiwmw ltlUrrrRN�MRNlrrf w.. IIINIIk+MNIaBWIUINNIrdI lYy�I1�ItlCJ«NLKYNN119MNWY.IWB6Y11�bItlgWrWWIUYYItlNINIlE111Y1�1lUiNItlIIYUIIIYIML <br /> P /PPROVED __IPPROVRD Vl1H CONDITIONS DISAPPROVED <br /> L TACINI17 VIll CONDITIONS) <br /> 1 FLIM REVIEWERS IIM6 i ar� r/�� �: r r—___Dil6— t' _/�'��� <br /> 1 <br /> APPLICANT MUST PERFORM ILL YORK IN ACCORDANCE VIfN SIN JOIQUIN COUITT ORD[NINCES, STIT9 LAYS, AND RULES IND REGUL/TIONS <br /> OF THE SAs JOAQUIN LOCIL RBALTH DISTRICT, OWNER OR LICBISBD 1GBNT'S SIGNITURB CERTIFIES THE FOLLOWING: 21 CERTIFY THIT <br /> IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL NOT EMPLOY IVY PERSON IN SUCH MINNBR AS TO BECOM <br /> SUBJECT TO WORKER'S CONPBIS1TION LIVS OF CILIFORNII.' COITRICTOR'S HIRING OR SUBCONTRACTING SIGNITURB CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY ?)if? II THE PERFORMANCE OF fill VORK FOR INICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> f0 YORKER'S COMPENSITI LI OF CALIFORNII. <br /> CA ECTIONS AT LEAST 40 HOURS IN ADVANCE <br /> --------_ --oils_ -1(0 <br /> OFF[CB USB ONLY--BH 21 041 1 /11 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSi4SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSStcs�SssSSSS <br /> SIBEPS t COMP I SOC CODE DIST C00 AMOUNT DUHAMOUNT RCVD CKI/CASA RC9D BY 0111 RCVD PERMIT <br />