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ENVIRONMENTAL HEAL T}( DIVISION APPLICATION FOR UNDERGROUND TANK CLOSURE PERMIT APPLICATION FOR PERMANENT/TEMPCRARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDCUS SUBSTANCE STORAGE FACILITY THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: —4 REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE EPA SITE ' CA2890090002 PROJECT CONTACT & TELEPHONE T BILL IRONS (209)942-1818 F FACILITY NAME LAWRENCE LIVERMORE NATIONAL LABORATORIES IP'c" # (510)422-0791 A C ADDRESS SITE 300, CORRAL HOLLOW ROAD I L CROSS STREET TESLA ROAD I T OWNER/OPERATOR PHONE T Y LAWRENCE LIVERMORE NATIONAL LABORATORIES (510)422-0791 C CONTRACTOR NAME HESS & HESS CONSTRUCTION, INC. PHONE # (209)942-1818 0 N CONTRACTOR ADDRESS 3819 DuCK CREEK DRIVE CA LIC ; 452648 IcLAssA,B, C-36,.ASBIIAZEM T R INSURER WORK.COMP.* A C FIRE DISTRICT LAWRENCE LIVERMORE NATIONAL LABORATORIES PERMIT # NSA T 0 LABORATORY NAMEL WRENCELIVERMORE VATIONAL—LABORATORIES PHONE N 3S R SAMPLING FIRM LAWRENCE 'L IVERMORE NATIONAL LABORATORIES I PHONE IIItIIlllf III1111lII}lIIIIIItI TANK ID TANK SIZEa�S� tM CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED 39- O�S" �IDIESELS to P r I X i�u) T 39- 2,000 GAL , 5-7 —/ DIESEL A A�A 6 A 39- N 39- K 39- 39- 39- P III II III 111}1 Ii tI!11 Il I!I}I II I I III 1f tI 11}II 1!1 I!I}I 11 11 1111}1111 III 1!III II II III Il I1111 III II II III 1!It11 11I It 111 If iI 111 11111 L APPROVED _ APPROVED WITH CONDITIONS) DISAPPROVED A (SEE ATTAC T WITHDITIONS) �j N PLAN REVIEWERS NAME (-A-- DATE III 11 lII Il III lI II 11111 IIl 111}}I1 131 II 11111 Il Ill lI 111 11 111111111111 Ill li 111 l 1111 II 111 Il Ill II}1111!I 11111 I}I II Ill Il 1111}Il til APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOACUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS 70 BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." APPLICANT'S SIGNATURE: 1XITLE PROJECT MANAGERDATE EH 23 046 (Rev 2/8/91) ft Page 3