Laserfiche WebLink
C I601E A <br /> UKDFRGfIND TANK �.11�rn <br /> i HAIELTON iIE. STOC <br /> jl ,. LOSURE �;.1NOONMENT Telephone (209)'460-34i� <br /> •' •'x�x►xr <br /> APPLICATION FOR PERMANENTITEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS <br /> ���V �8 1989 <br /> US SUBSTANCES �jO <br /> THIS PERMIT EXPIRES 90 DAYS FRO THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICAIL <br /> - TE PERE <br /> . <br /> �EEv�1TLTTE <br /> --- REMOVAL __--- TEMPORARY CLOSURE f <br /> .__- ABAN00NMENT IH PLACE 1; s <br /> EPA SITE 14R1 S9 3 <br /> !' S S G PROJECT CONTACT i TELEPHONE # `a <br /> F FACILITY NAME / �� K l / 4,-70 r -.�3 c1l-O {� �7 <br /> A t=7 �° <br /> PHONE # <br /> C ADDRESS d 3� ` �r>o <br /> i <br /> Pr <br /> L CROSS STREET eA c.J S a L!l � <br /> T OWNER/OPERATOR <br /> YRYL PHONE t <br /> C CONTRACTOR NAM O"� - - 6 U V <br /> E <br /> O PHONE #. tFf_52,4-� S� <br /> N CONTRACTOR ADDRESS y3� "d�� lea• rn 1 <br /> T QS7`a CA LIC #qyct%(,y CLASS <br /> R INSURER Fu� ��_�� <br /> A rS. WORK.COMP.#! Rc 5 <br /> C FIRE DISTRICT i <br /> T PERMIT #/INSPTR 4 <br /> 0 LABORATORY NAMEn i 'j <br /> R l �l-l� f+`JRT�� �-�� PHONE # 9�G9 <br /> SAMPLING FIRM* �Ar,r�• WP7f-P,- Lr-t& <br /> smsmSAMPLING METHOD <br /> TANK ID 1 <br /> T TANK SIZE CHEMICALS STOREDICURRENTL CHEMICALS STORED PREVIOUSL <br /> A <br /> K 39---- STE O <br /> 39- <br /> 39---------------------------- <br /> P +� <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> L APPROVED —APPROVED KITH CONDITIONS ___ DISAPPROVED <br /> A PLAN REVIEWERS NAME ___ ;S- TTACHMENT WITH CONDITIONS) 1. <br /> NI v_F ------- -------- -----------------------DATE.___ - <br /> APPLICANT MUST PERFORM ALL YORK IN ACCORDANCE WITH SAN JOAAUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO DECOR <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA,' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT ISISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA <br /> E <br /> CAAOR INSPE TION AT LEAST 48 HOURS INIADVANCE <br /> k <br /> SIGNED _ <br /> Off[ USE ----------- - ---------- --------------------- Ip DATE-L! a 7 ��_ .,._ <br /> USF ORIY--flf 13 4�6 12/88 -------------------- - <br /> tfifitffffffftf;tif;;t;Tiff;fttifft;f;fffffiff;f;ftt;;itfifftff;fff;t;ffiffftfff tffifffiff;;;;ffffftfffftfiffff <br /> SWEEPS COMA L CODE DIST CODE AMOUNT DUE AMOUNI RCVD CKt/CASH RCVD'8Y DATE RCVD p�jTf�;f <br /> L � <br />