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fi <br /> ro ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND ,TANK CLOSURE PERMIT <br /> Aa FACILITY <br /> Arrl.l <br /> CATION FOR PERMANENT/IEHPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERCRpDAREASRDTgbl AW PERMIT TYPE BELOW: <br /> TH15 PERMIT EXPIRES 90 DAYS FROH`IHE APPROVAL DATE. Do Not WRITE 1N ANY SHADED <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> PROJECT CONTACT b TELEPHONE Richard T�]Orpe'a(209)368-6175 <br /> ErA SITE N CAC 000701832 b <br /> PHONE 0 (209)943-5000 <br /> F FACILITY HARE Paneila Trucking, Inc. <br /> A <br /> C ADDRFSS 2150 E. Freniont St. Stockton, CaiiF. 95215 <br /> P <br /> L CROSS STREET U St, <br /> Inc. (209)943-5000 <br /> T ovHER/DrFRAIOR Pas]ella Trucking,. PHONE R <br /> y <br /> PHONE N <br /> C CONTRACTOR NAME Jiln ThouLe Oil Inc. D.B.A. Bich-Marc Cotlst. 2U 68-61 <br /> CA LIC NI CLASS B llax. <br /> H CONTRACtOR ADDRESS f'v. Bx. 357 Lodi Cal. 9524 1-0.35' I 5 <br /> t WORK.COHP.1 1095135-90 <br /> R INSURER f' l 1'RI�1:1rc; <br /> A p,,,,,, ]r Fire perinit will be <br /> C FIRE DISTRICT City of Stockton .' <br /> -obtaimed-upoa-UPs <br /> 1 PHONE N (?09)572-0900 <br /> n LARORATORY NAME GeOAnalytical La.boratori2s, Ir]C` <br /> R PHONE 0 (209)572-0900 <br /> SA!]P1,111r, FIRM I Scl1T]e,ias above <br /> I 11111111N1#11#[ <br /> - IIIIIIIII ILII ` <br /> ,. -TANK 512E CHEMICALS STOR <br /> ANK 10 <br /> fb CURRENTLY/PREVIOUSLY BATE UST INSTALLED <br /> N <br /> / _ <br /> 3v _�/��� 12000 g - ie - <br /> A 39- <br /> H 39- <br /> -- 1111 lillllllllllllllllllllllll[11111 illllllllllllllllilllllllllllllllllllll IIIIIIIIIIIII[lllilll <br /> 11111111N111#1111#I#INTI - <br /> P ` DISAPPROVED <br /> L (/APPROVED APPROVED WITH ;CO►IDITION(S1 <br /> i5EE�,i1AC11 <br /> A ENT WIiH CONDITIONS) <br /> /1/, - J— i — DATE M <br /> N rT AH REVIEWERS NAMF iiO <br /> -- <br /> -- 11111[lllllll1111111Ai1llllil[lllfl[illlll#111N[[I[IIIII[III[11111111[I[[[I[il�ll[Ilill[illi i11111i[I[Ililllll[I[Il <br /> 1111111 <br /> ArPLICANT musT F,ERFORH,ALL WORK IN ACCORDANCE WITH SAH JOAQUIN CdJNTY ORDINANCES, STATE LADS, AM RULES AND RCERO <br /> SAH JOhoUIN COLR]tY PUHLIC HEALTH SERVICES. DOWNER OR LICENSED AG�AILSHOTGHAVURE ENPLOY AHYTPERSONtHE FOLLOWING' <br /> IN SUCH 11A140NERIASTto1FYTH BECOME <br /> i IN <br /> THE PFRFTTRMAHCE OF THE,,WORK FOR Milt" THIS PERMIT IS ISSUED, I S, <br /> sl]R.]Er.t t0 TOR <br /> WORKER'S coMPENSATTON LAWS OF CAL fFORN1AUIITCHOIHTSCPERRTTHI511SSUEDNG OR SU)CSNALLCEMPLOY IPERSONS SUBJZCTEToTWORKER'S�ING: <br /> "T CERTIFY THAT IN 111E.PERFORMANCE OF THE WORK FOR <br /> COMrENSAIIDN LAWS OF CALIFORNIA. moi" <br /> DAIE �_' <br /> APrLICANI'S SIGNATURE- C• N <br /> Pnge 1 <br /> EH 23 046 (Rev 2/8/91) It <br />