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��. UNUt huktuUNU 'TANK 16U1 E HA'LELTON A `'( ISTOCKTUN CA <br /> CLOSURE OR ABANDONMENT JI Telephone ( 209 8-3928 <br /> II <br /> Ni <br /> APPLICATION FOR PERNANBNT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HASARDOUSASUBSTANCIS GTORAGE'FACILITY <br /> i. TRIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE, DO NOT BRITS IN ANT SHIED AREAS, INDICATE PERMIT TTPE BELOW' <br /> X REMOVAL TEMPORARY CLOSURE ABANDONMENT:IIN PLACE ' ' <br /> ------------- <br /> r F PROJECT CONTACT PHONE # ' 209 j 754-1808 <br /> A KEITH A . TALLIA <br /> I FACILITY NAME — — -- ADDRESS 45 E .Harding Way,` Stockton <br /> -- ... --- r-- - <br /> L OWNER ADDRESS <br /> I Chevron USA , n <br /> Ic . PO Box 5OO4 , San Ramon,CA 945 -0804 <br /> T CROSS STREET PHONE # 415 / 842-9500 <br /> Y , -` .. - ------ E1 Dorado <br /> C CONTRACTOR NAMEPHONE # 209 /-754-1808 <br /> O — — —_Oil .Equip ;!is ervice <br /> — <br /> N CONTRACTOR ADDRESS -PO Box .950 # <br /> CA LIC <br /> T I San Andrea_ss—CA 95.2.49 323417 <br /> R GIC CLASS WORK COMP . N INSURER <br /> A ( A ,C61D4O, HazlState Comp . <br /> C FIRiDISTRICT — PERMIT # _ <br /> T Stockton C'i_ty _ 1 <br /> 0 LABORATORY NAME Pace Laboratories PHONE N 415 / 883-6100 <br /> R ------ <br /> SAMPLERS NAME SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID # CURRENTLY PREVIOUSLY <br /> E --- - - -....... <br /> M 550 Gasoline ? TO ? None <br /> I 3000 Gasoline ? TO ? None <br /> C 4000 Gasoline ? TO ? None <br /> A TO <br /> L LISt ANY EXTRA TANKS ON A SEPERATE SH ET _ <br /> P <br /> L ? (SEE ATTACHMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME DATE <br /> N <br /> APPLICANT MUST PERFORM ALL FORK IN ACCORDANCE PITH Sig JOAQUIN COUNTY ORDINANCES, STATS LAFS, AND RULES AND RRGULATIOES <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CEHTIFIRS TER FOLLOVING: .'f CERTIFY THAT <br /> IN THE PERFORMANCE OF THE FORK FOR FRICH THIS PRINT:IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOME <br /> SUBJECT TO FOREMAN'S COMPENSATION LAYS OF CALIFORNIA:" CONTRACTOR'S HIRING OR SUB-CONTRACTIEG SIGNATURE CERTIFIES THE <br /> FOLLOVING: 'I CERTIFY THAT IM THE PERFORMANCE OF THE]YORK FOR FRICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT <br /> TO FORKMAN'S COMPENSATION LAYS OF CALIFORNIA. COMPLETE DRAWING 01 ATTACRED PLOT PLAN SHEET. a <br /> CA F R 'LL. S Y- INSPECTIONS AT LEAST 98 HOURS IN ADVANCE <br /> .i <br /> SIGNED X eith A . Tallia TITLE: President DATE:N' tuber 16 , :1988 . <br /> ACCEPTED BY TITLE: DATE: <br /> vk <br /> IM <br /> Cpl_ <br />