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�, AOR <br /> IVtit:I tt:kl�ti.t3:trIt:ti:R:ti: tl:R: i-tt*R:t ,ti'It:it- <br /> 4 dPPL1 PERMIT SIH JOIOUIH LOCAL HEALTH DISTRICTv <br /> t: UVDERGR0UVD ?INK t: 1601 I HIIBLTON APB., STOCIT01 Cl... ,. Y <br /> I: CLOSURE OR IBINDONMEYT t: Telephone (2011 168-3120 <br /> t= <br /> t'tt�ti�t3�ti�tt�ti�tt=tt�ti'ttt=tt�tt�ti�ti=ti-tt�tt�tt�ti'kt�ti=ti tt=tt�t;�ti�ti=tt'tt'ti�tt'ti� <br /> APPLICATION FOR PERMANENT/TEMPORIYT CLOSURE OR IBANDONHENT*IN PLACE OF UNDERGROUND HIIIRDOUS SUBSTANCES STORIGE FACILITY <br /> THIS PERMIT EIPIRES 90 DdYS FRDM THE APPROVAL DATE. DO NOT WIIT8 IH III S1lADK) AREAS. INDICATE P8RN17 TYPE IELOY: <br /> X REMOVAL TEMPORARY CLOSURE ISINDONMENT IN PLACE <br /> EPI SITE 1 PROJECT CONTACT I TELEPHONE 1 Gary Trumpp <br /> CAC 000191543 408- <br /> F FICILITY NAME Breuner� ::1PHONE 1 <br /> 292-0820 <br /> l 209-476-8 5 <br /> C ADDRESS <br /> 1 7676 Pacific Ave. Stockton <br /> L CROSS STREET Hammer Lane <br /> I <br /> T OVNER/OPERITOR PHONE <br /> _Y Breuner's - 415-866-4300 <br /> C CONTRACTOR RIME Trumpp Bros. , Inc.General Engineer. PHONg # - <br /> 0 _ <br /> I CONTRICTOR ADDRESS CA LIC 1 T CLASS T 1540 Industrial 324079 A <br /> R INSURBRContinental CAS (CNA-S. F. ) - YORK.CoxP.l 704717641 Exp. 7-I-90 <br /> 1 <br /> C FIRE DISTRICT PERMIT 1/INSPTR <br /> T Stockton Fire Dept. <br /> 0 LABORATORY WINE <br /> Brown & Caldwell PHONE 1 415--428-2300 <br /> R . <br /> SIMPLIYG FIRM' ke SAMPLING NETrOD <br /> uru�►uu��uuuuu�w��uu��u�mu�u�ruuuy�i�' • <br /> TANK ID I TANI 5128 CHEMICALS STORED CURREXIL CHEMICALS STORED PREPIOUSL <br /> T <br /> 10,000 <br /> Diesel <br /> LIST ADDITIONAL ?INK INFORNATION IS NEEDED Or SEPARITE FORK <br /> IIIUIIDI�IIOU�ItW�11O DkWUIWIE�IkWIUIIIIIIWWII�RGItIIWUID611�II�IRGWIdfII1WWIIWI1111SIC�W�p�iI�fGY�YS�D�iNmGtf1 <br /> P APPROVED _IPPROPED WITH CONDITIONS _ DISAPPROVED <br /> L <br /> I PLAN REVIEWERS NINE ER TTACBMENT WITH CONDITIONS) <br /> ` bATg •- -� <br /> APPLICIHT MUST PERFORM ILL WORK IN ICCORDINCE WITH SIN JOIOUIN COUNTY ORDINANCES, STATE LAYS, AND RULES IND REGULITIONS <br /> OF TRE SIN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY TELT <br /> Ir THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL 901 EMPLOY ANY PERSON IN SUCH MIYHER AS TO BECOM <br /> SUBJECT TO YORKER'S CONPENSITION LIPS OF CALIFORNIA., CONTRACTOR'S HIRING ORSUBCOrTIACTIHG SIGNATURE CERTIFIIS THE <br /> TO WORIER'S COMPENSITION LAYS OF CILIFOR111. <br /> FOLLOWING: 'I CERTIFY THAT [N THE PERPORMINCI aP THE WORT FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> CALL OR INS ECTIONS AT LEAST 48 t10URS IN ADVANCE <br /> SIGNED DATITg <br /> OFFICE USE <br /> ONLY•- 23 016 121 <br /> S#S SSSS#SSS##SSS #SS#SSS#SSSSSSSS#SSSSSSS#$##SEES#S#SSSSSSSSS$SSSSS#SS$SSSSSS#SSS$SSS$$S#$$$$$SS$#$$$SS$$$#�$$$$S#$#$$$$ <br /> Sy EPS I COMP I LOC CODE DIST CODINOUYT DU11 lHOIIHT RCVD CII/CAS CVD u, DI R D PERMIT <br />