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t:tv ti.orti:tt:ti:R.tir ti:ti:ti:tv ti:tt:n:ti:ti:tt:ti:ti:ti:ti:tt:Ott:ti:ti:ti:tt: <br /> IPPLICITION FOR PERMIT SAN JOIQUIN LOCAL HEILiN DISTRICTt: <br /> t: UNDERGROUND TANK t: 1601 B HItSLTON 1V8., S10CKTOI Cit: <br /> t: CLOSURE 02 1IINDONMENT t: Telephone (109) 168-3110 t: <br /> t:ti:ti:Wtt:ti:tt:ti:ti:t1:tit:R:ti:ti:tt:tt:ti:ti:tt:ti:ti:tt:ti:ti:ti:ti:ti:tt:ti:ti,ti:ti:V. <br /> IPPLICITION POR PBRMAMRKT/t1MPORIRT CLOSURE OR 1BAIDONNENT IN PLICB OF UNDERGROUND NIIIRDOUS SUBSIINCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DIPS FROM THE APPROVIL DITE. DO NOT YIITB IN III SHADID AREAS. INDICATE PERMIT TYPE IELOV: <br /> REMOVAL TEMPORARY CLOSURE , 1811DONMBNT IN PLICI <br /> EPA SITE t �� -� 062® � PROJECT CONTICT A TELEPHONE Izra# / w93 <br /> F FICILITY NAME /j &POS- PIIONE 1 Z- `) Z U <br /> 1 <br /> C ADDRESS n� <br /> 1 1J <br /> L CROSS StRNT <br /> 1 — <br /> 1 OYNER/OPERATOR Uv PHONE <br /> Y t�z <br /> C COIITR1CIOR NINE ., PHONE <br /> 0 <br /> NCOIfRICTOR ADDRESS <br /> T A [C I CLASS <br /> R INSURER 'r—�f?L__ �__.__� YORK.COMP.) /,i1 AQ <br /> ce _ <br /> C FIRE DISTRICT 4 � � Q PERMIT 1/[NSPTR <br /> 0 LABORATORY NIMB �' /' �J S• PHONE <br /> R C�'T rG' <br /> SAMPLING FIRMS � �L SIHPLINC NEtYOD �- <br /> mVG171DImmUmWVVVUIVmVtQVIVlNYVVDVVUVVVINVIVVYViVm1VVp - <br /> TAYK ID 0 TIKK SITE CHEMICILS STORED CURRFITLI CHEMICILS STORED PRIVIOUSL <br /> t <br /> 39- <br /> __. LIST IDDIIIONAL TANK INFORHITION AS NEEDED ON SEPARITB PORN <br /> VI�IVGUUUmVmVUVpVVVIVVVVIVmVmmYlml IUtlVVUUVVVVVIIimpmVUIIIVIVII�UVVC9mtUIV;lli!VmIJIIIUIIVUUDUVVVUCUI!UIBCmiIGIUUIIt9Vy"�!1'1JClCN:!IT4CIIIUUIVYAV!IUIU:IIUIUL'mUIVVIIIVIUIWmtlIUVUL'mVIId;UCWUImUIIIIVtNUVUIYmmYI:,, <br /> P UPROVED _ IPPROVRD PITH CONDITIONS DISAPPROVED <br /> L (SEB ITTICHMENT KITH CONDITIOYS) <br /> I PLIN REVIEWERS NIMB <br /> um�mmuuduYrYmmuYUR�uYdmumlmllummmaumYtmwluumminmuuaamYYluulluYm>uYuuwul�wmYmllYlwmmuaY <br /> IPPLICANT MUST PERFORM ILL YORK 11 ICCORDINCE IItN SIN JOIQUIN COUNTY ORDINANCES, STOR LIPS, IND RULES IND REGULIT[ONS <br /> OF THE $11 JOAQUIN LOCAL HEALTH DISTRICT. OYNER OR LICENSED AGENT'S SIGNITURB CERTIFIES THE FOLLOVING: Of CBRtIFY ?HIT <br /> IN TUB PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL 101 EMPLOY ANY PERSON IN SUCH RANKER AS TO BECOM <br /> SUBJECT TO YORKER'S CONPENSITIOM LIPS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAI IN THE PERFORMANCE Of THE YORK FOR YHICN THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUDJRC <br /> 10 YORKER'S CONPENSITION LIPS OF CILIFORYII. <br /> CALL FOR INSPECTIONS AT LEAST 40 FLOURS IN ADVANCE <br /> SIGNED DATE <br /> OPFICS USE ONLY--BIL 13 016 12/81 <br /> - —��-- -- <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSISSSS <br /> SYBEPS I COMP 1 11,11 CODE DIST C 1NOUNT DUH AMOUNT RCVD CKI/CASB BY Dill RCVD PERMIT I <br />