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ENVIRONMENTAL HEALTH DIVISION � <br /> APPLICATION FDIC UNDERGROUND TANK CLOSURE PERMIT RECEIVED <br /> APPLICATION FOR PERMARERT/TEMPORARY CLOSURE OR ABANDONMENT LH PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAJUl�-IfI14 MI <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS INDICATE Ill"W N AL HEALTH <br /> _XL REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE RERIYII Tf SEROCES <br /> EPA SITE 0 CAC 000623184 PROJECT CONTACT t IMPHONE 0 Martin Thorpe (209) 462-4581 <br /> F FACILITY NAME Sierra Bay Farm Credit Service <br /> =PHONE <br /> A {209} 931-3710 <br /> C ADDRESS 18775 Tom Paine Road, Tracy, CA <br /> I <br /> L coos' stAlEr Carnal Street <br /> 1 <br /> T DUNER/OPERA)OR Sierra Bay Farm Credit Service Eliot Appleton PHONE A (209) 931-3770 <br /> r <br /> c CONTRACTOR NAME Jim Thorpe Oil Inc. / D.B.A. Rich-Mart Cor13t, PHONE (2091368- <br /> ° 6175 <br /> 351 N. ec an Rd <br /> N CONIRACTCR ADDRESS Po. BX. 357 Lodi Gal. 95241-035CA LTC 'I45b CLASS A B f aZ <br /> 1 <br /> R INSURER ['i vf'IIl iw, H u id / Admiral WORK tom-" 1095135-90 <br /> A <br /> Cr39 <br /> T San Joaquin County PERMIT #Fire Aermit will be <br /> oAME Weston Analytical PHONE A (209) 983-1340 <br /> R <br /> M same as above PHONE I same as above <br /> K 10 TANK SIZE CHEMICALS STORED CURRENTLY/PREVICIUSLY DATE USI INSTALLED <br /> 1 350 q_al . Re 7�rasoline <br /> A <br /> H 39- <br /> K 39 <br /> 39 <br /> 39 <br /> P <br /> 111[11111111111111111111#Illi# <br /> L 7V— APPROVED APPROVED WITH CONDIFION(S) DISAPPROVED <br /> A (SEE ATIACIIME WITH CONDI T S) <br /> N PLAN REVIEWERS NAME G,.�. �-G-- DATE �`l1 <br /> f�if�fr«ter#rl��if�l��ff�fifff#ff�Il��l�f���flfflfff�ffff�fitflffllff� fffflfffff�fflf�flfffffffffifffffffffftffffflfflffir <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAH JOA UIN COURTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES D41NER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "i CERTIFY THAT IN <br /> RHE PFRIORHANCE OF INE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO $ECOHE <br /> SUEJECT To WAkER'' COHPENSATIOH LAOIS OF CALIFORNIA " CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWFNGs <br /> "I tERIIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SLSJECI TO WORKER'S <br /> IfRSArION LAWS OF CALIFORNIA " <br /> APPLICANT'S S(CNAFUREs II ILE __Contractor -- - DATE _711-8191 <br /> EH 25 046 (Rev 2/8/91) Ft Pepe I <br />