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l/df T1kUStEE$ SAN JOAQUIN LOCAL HEAL I H uitii lilt,t BanJosquln County <br /> Cns al Mortises <br /> ,w.pre". 1601 Fast Ht3ielton Avenue City of Escolon <br /> rneniol.%lee pros. Stockton.C®liiornia 95205 Clry al Lod1 1 <br /> rmy Joyce.Secy. Ciy al Tracy <br /> nes F.Culbertson .1001 KHANNA. M.O., MY-14., p1971iIGT HEALTH QF!'ICEI# Cly 01 mpon <br /> j-.--h,Most M.D. gan Joaquin County <br /> h Met!,y.vs City of Stockton <br /> i homes Schubert D.V.M. OAn.lNWn County <br /> 17epfine Sfiev+ <br /> wdrveyYYlnleme,Ph.D. PERMIT 70 CLOS <br /> APPLICATION FDR <br /> UNDER ROt1Nb STORAGE TANKS STOIRING HAZARDOUS MHTERIAI,S <br /> INgTRuc TIOt1S l,. CbWLETING TI119 FORH <br /> FACILITY SECTION: <br /> I. Complete form "APPLICATION FOR PFRHIT FOR UNDSRCROUHD TALAR CLOSURB". <br /> :,,,obtain assaeite Huwitb undergeoundltank2te®ovalls�t temporary hasatdouB haste removal <br /> acts <br /> veiecord name, addresnc�toldesncaperator,st andttelphene n°abet of the location of tht <br /> nd g tan <br /> CONTRACTOR SOCTIOR: <br /> 1. dace, address, and telephone nuaber of contractor perfotaing regoval ectivitles' <br /> 2, Conttaetorre current Callfotate License and yCansEileswlthwtitiiBpeEEic2t current ol:Aette <br /> Ceepensatlon Insuratirs, or Indic pppp b p bb t <br /> 3. Record the firetdistmitt andSobtoln thetf1te e9d sftictttegultesethAtctbeeDJ� Dopetaltub4llasnetl <br /> the APplicatlo the fire district petst nuiber Bhpa aa1 ut` <br /> prior to obtalningg he necessary Etre dist ict permit, Reins actlIia tern afll11be charged <br /> b here Essar plicennis Burin tank cl° uvltles.p Falls to pt r! a proof <br /> verified on sitey <br /> of fire district petnit will tesult in cancella ion of inspection. <br /> fox repeat visits. <br /> .4. Recordthe <br /> contracted ltberaaleyof name <br /> a pling telephone number. lt1l tonttacted sampler is <br /> dilferent <br /> 5. Record the method of sample collection. <br /> CHEHICAL SECTION: iDO Not Write in Shaded Areal <br /> 1. List all materials stored, ar previously stored, In the WWI- <br /> 1. <br /> INFORMATION: g r <br /> 1. DISPOSAL INFORHATION: San JoageltssncalaReldenkl11catlonsnumber v InbegJLltOis tecrBeen atdve viii <br /> removed frog site. ,ank(si trail 6 t� g <br /> nota onathe rackinntaaeet and�aloikstace tovaelttanspotted ID Number Manlfe6tf ytiacent <br /> licensed haaardous waste .raulet. <br /> Z, CONTRA TOR TR PPOyxeavatlonUw�a+eguateanuibee �ed detectortovypef fL6Lrateot�ngul"Holt <br /> he tank <br /> riot to lifting cam t + tt p t Ina 4a a� te5 sssl l for <br /> tc sec,re the area as necessat to alnlafie ttag�la Pepe pioelct an ante;tt+rence, Hot stent <br /> Cattlets b <br /> spraypaint to afflll tankns? ldentllicat[on number. f p ii gg go <br /> spray ance with eI1 healt an asfentaavieaacElyit es,tequlrement$ sflall �2 BEtlttlr mahere o �t <br /> ami tiles during the course of the <br /> CLOSURE 10 PLACE: <br /> v <br /> a¢a 11a: ry o <br /> un n *ee <br /> s u <br /> u <br /> fl Ft <br /> s <br /> EN 23 015 ' <br /> ..... ; .. <br /> _ .. . ..._ .. .; <br /> Envlronmenlal Health pubno Heeiltt Nurldnp <br /> Administration Clinical Services 466-3420 Ada 3860 <br /> 46B•3400 468.3830 <br /> 1— Community services laboratory 608.3260 <br /> Air Pollution 460.3820 468-3460 <br /> AIDS Inlarmstron 46B-302o <br />