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SAN JOAQUIN COUNTY PUBLIC HE LTH SERVICES <br /> ENVIRONk.1ENTaL HEALTH DIVISION <br /> APFLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> HIS?ERyt:T FCR?ERMANEN E- pop.AR`�CLOSURE OR AeANDONMt?NT IN°L4Cc OF UN."•ERGROUND�IAZ+BOGUS SU6STa�1cES <br /> STORAG=rA,yK gI EXPIRES 9Q TEM FnGM THE APPROVAL CATE.=. CC NQT+NRITE IN ANY SHADED ApEAS. INDICATfi pj2PN41T TYPE <br /> ff REMOVAL <br /> 0 TEA�IPORF�RY CLOSl:1�E G CLOSURE IN PLACE <br /> FACILITY INFORMATION <br /> pr-.c,jecT ccNtACr Richard Thorpe PHONE# 209)368-6175 I <br /> SPA SffE# I PsONE: — <br /> FA,-.Ll-;Y NAME ° 1 mire <br /> _I accREsS co s ve. , ockton, A 95203 _ <br /> rCRCSS S->� into n <br /> �f,oNe 256 435-870 <br /> OWN?CcER°TOR <br /> CONTRACTCR 1',14FORMATION <br /> PHCN <br /> CONT ZACTOR NAE Jim Thor e CA ,, I CA L IC$ CLAsS <br /> CCNTrAC-CR ACCPESS P .0. B 57 NO}ZK_R CCMp# <br /> NSURER Genstar/Golden Ea le PEa�1T$ upon approval <br /> F;RED;S-p,:cT The Cit of Stockton _ <br /> ff <br /> LAECFAT7RY NAME GeoAnal tical Labs. °Labs clvE # 209)572-900U(209 72-0 <br /> "FUNQ FIRM <br /> TANK INFORMATIC'N <br /> G TANK CCN:c`�+S(?RESENT 4 ?ASS' OATS:NSTCLLED <br /> �-A.NK I TANK SIZE I unknown <br /> 39. 0 3d 500 leaded gasoline unknown <br /> 13or _0 ! 500 leaded gasoline <br /> 139- I <br /> 139- <br /> A➢DlIC.1NT�7UST PERFORMALL vrCRK `�ACCORDANCE WMi SAN.AAQUIN :C'UNTY CMtiANCES,5-:.-'E LW;S FEfol.\AL LAWS.AIV.".' RI�=S ANO <br /> RF;:J.,�T pyS CIF -AN JCAQUIN =', '14`.'1UB VQRK CR L�AiICW CH PSRaAITINEA AS <br /> pS SSUEDCot NSSHAL�.N T EVPLCENTS �ANY P RSCN IN HE <br /> A+tA�TUPS a.iFIES <br /> CEPriFY THAT iN THE?R?FCR"+ �_DF <br /> E+ <br /> `•I_ P_RFORMAh=_OF THE'• ORK F.?',N►IIG THIS PE'rWdiT IS!SSUE7.I$HA_L EAIPLC"Pi <br /> .R,$ SUB�c:T TC <br /> TC c.G.'�!S suai=_cr TO vVORt 'S COM°9NSAT10V 1„ JS CF CAL:FORNL1; ^,01vTR:CTCR'3 HIRING'CP.$UgCONTRACrNG SIGNA <br /> 74E!CLLOwNo: '1 cErnFY THAT IN i. E A, <br /> ,%v:!!Fxs COL1F9NSA'I1CS LAWS OF CA' / <br /> n7LS Contractor DAr_�1 <br /> A�PLCA•P!T'S S+Gi`,ATLIP.E <br /> 1 ❑ APFRGVEp PPROVELD WITH CONGiTIONESi G DISAPPROVED i <br /> SEc coNcl'Icns 8__CYJAlVC70R ON?rfACHh1cN� 2 <br /> I! <br /> CA TE J <br /> PlJ",N REV EWERS NAhAe <br /> re• 1A^ONS F cOM THIS A?�t1CaT1C`I MUST:E SL!BUIITT'cD TC$HC FAf2 �`aPRVJAL PR•OR TO COM1IIA=NGiN tiS°�li• <br /> fk ANY OONDiTI NS: <br /> ij <br /> I' <br /> p�ga 3 <br />