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..� Nwe <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APFL.ICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PERti1:T FOR?ERMANEN�rET.iFOFr"R"CLOSURE OR AeANCONMENT IN PLACE OF UNCERCRCUND HAZ4RDCU5 SIisSTa4CES <br /> yTOrZ1GE 7ANIC,SI ?iRcS 40 LAYS FriGy1 THE <br /> APPROVAL CAT E. CC NCT INR 'E IN AhY 3NAC=D ARE-AS. INDICAT=PcR JIIT TY�c <br /> L REMOVAL Ej T=MPORARY CLOSURE 0 CLOSURE IN PLACE <br /> FACILITY INFORW"TION <br /> PFOJECT CONTACT Richard Thorpe PHONED 209)368-6175 <br /> SPA SITE iF 1 PHONE: — <br /> FAC 111(VAMC O 1 mire <br /> _I Accassa co s We. , Stockton, A 95203 <br /> rc,CSSS.F.F into n t . ; PONONE4 256 435-8701 <br /> OVIN�'�CocR°74R <br /> CONTRACTCR INFORMATION <br /> caNTRACTOFctVANIE Jim Thor a ( PN�g <br /> C,ONTRAC-OR ACCRESs P.O. B 357 . C ICA LIC - CLASS <br /> i%suRER GenStar/Golden Ea le ( AVORxERCOMP <br /> FR°DIS-R:cT The Cit of Stockton I PEa�tT* upon approval <br /> !,>BCRATORY NAME GeoAnal tical Labs. - COUN^' Stan. ; QHONE>r(209 72- <br /> 0900 <br /> �,. 572-9000 <br /> 3:.:r_iNG FIRM <br /> TANK INFORMATICN <br /> -A;Vi(.ID i ANK SIZE I TANK 0CN7-ccN7S!PRESENT 4 PASS I TATE INSTt;LLED <br /> � I <br /> 39- 500 leaded gasoline unknown <br /> 1139- =O � II 500 <br /> i leaded gasoline 1 unknown <br /> i. <br /> 39- <br /> APD!IC� T MUST PERFORM ALL VJCPK:N ACCORDANCE'vIATlt SAN JCACUIN :�U rTY G=C:pLANCES,ST:."E LW;S RRCiE.tAL LAWS,A.N^ ZLLa ANO <br /> 'I <br /> R-t3J..A71OyS CF £AN JCAQUIN CvV "PUBLIC F(!-\LTH SEWCES. Ot:,NEp, Cst UCE45cG AGENTS SIGtia URE CERT;FIeS P�RSC4 1 = =CL-O4NNV1 <br /> CE�riFY THAT IN Tm!PLPFCX AANCE OF_i=..VORK FCR'.M41CP THIS PSAMIT S:SSUED I SMALL NOT[,V, y SUCH A�AA!lNER.45 <br /> CCM°=tSA- lllJS C=CAUFORNLI- W?4TRAC7CR'3 41RIMC CP 3i: CcomTRACT:NG"sIGNATUFS CL.-IFIES <br /> TIE�CLLC1l+1Nv: 'I CEn i�N THAT;N '!-E P=:FORhtA�=E OF ItiE'. ORK r_P'J�Y1C-THIS PEnb11T IS!SSUEO t SHA_!EtAP!C"PGPSONo SU6�c:T TJ <br /> >CF!E?'S CCMFSNSATICS IA%VS OF CA' - ';A' <br /> TITLS Contractor DAT= e' <br /> I ❑ APFRGVED ' I PrROVED WITH CONOMON(S) G DISAPPROVED <br /> I SEE CCVC1-ICNS B2--.QW ANC/OR ON ATTACHhI_N r; <br /> ji � <br /> PLAN AEL1E•A1ER'S INAAAF <br /> I <br /> ANY °` IA-;ONS FROM THIS A?-'LICaTIC"1'dU3T':E 3f!EMITTE0 1-0 EHC FOR APPRC"!aL?R+t7Fc TO COMhI?=HCIN 1,VCL� <br /> CONDIM NS: <br /> �I <br /> t C3•2,E(RE'115a0 Q:Ir1',/9S, P�ya 3 <br />