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�" . <br /> ENVUtONMENTAL HEALTH DIVISION . <br /> APPUCA71ON FOR UNDERGROUND TANK CLOSURE PERMIT 00014 <br /> APPLICA71ON FOR PE3tM[ANENTnTMMRARY CLOSURE OR ABANDONMENT <br /> IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK- <br /> THIS <br /> ANKTHIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. <br /> Do NOT WRITE IN ANY SHADED AREAS.INDICATE PERMIT TYPE BELOW: <br /> X-REMOVAL RARY CLOSURE CLOSURE IN PLACE <br /> EPA Site K Project Contact&Telephone M <br /> F CA2890090002 C.Susi Jackson 510 423-6577 <br /> A Facility Name Phone M <br /> C Lawrence Livermore National .Site 300 510 423-4881 <br /> I Mailing 7000 East Avenue.P.O.Box SM.Livermore,CA 94550 <br /> L Site Address.Corral Hollow R2A south of LrAM <br /> I Cross Street <br /> T located 15 miles east of Livermore an Corral Hollow Road Tesla Road and Hi hwa 580 <br /> Y Owner/Operator-U.S.Government-Department of Energy. Phone N <br /> Universiry of California 15121423-6577 <br /> CauractorName Phone# <br /> C 9 EX NOTL& yo--4St,-64ws <br /> O CawacxorAddress CA Lic r Class <br /> N %SCOrn 2nt ,..30S5- 0 03.9T AL <br /> T Durr Work.Comp.# <br /> R T.G. -4-00 <br /> A Fiat District Permit N <br /> C U.NL Site 300 Fire 25aMent <br /> T Laboratory Name Phone 0 <br /> O Clavton Environmental Consultants 510)4262600 <br /> R Sampling Firm Phone N <br /> Environmental Pnxection Demnrnent 51 423.6577 <br /> Tank ID a Tank Size Chemicals Stored Carreativ/Previousil Date UST Installed <br /> 39- 45--.2 7 280 Wions diesel furl Unknown <br /> T 39- <br /> A 39- <br /> N 39- <br /> K F39- <br /> PP Approved Approved with Condition(s) Disapproved <br /> L ( Attachment wit® Conditions) <br /> A / _ Y <br /> N Plan Reviewers Name 4x J 2 Date /) <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH S •JOAQUIN COUNTY ORDINANCES.STATE LAWS,AND <br /> RULES AND REGUIaT1om OF SAN JOAQUIN COuNry PUBLIC HEALTH SERVICES.OWNER OR LICENSED AGENT'S <br /> SIGNATIURE CER71M THE IFOLIAWL : 'I CERTIFY THAT IN T,14E PERFORMANCE OFTHE WORK FOR WHICH THIS PMU T <br /> 1S: V='- .I S'-iA! NO T EMPLOY ANN°EP.SON IN SUCH AMA gVER AS TMJ BECOME SL=jTXT7C1 WO?JARS CONVIENSATI7': <br /> LAWS OF CALIFORNIA.- CONTRACTORS HIRING OR SUBCONTRACTING SIGNATURE CT:RTTFIF_S THE FOLLAµTNG: Z <br /> CERTIFY THAT IN THE PSUORMANCE OF THE WORK FOR WHICH THLS PERWT IS ISSUED.I SHALL EMPLOY PERSONS <br /> SUBJECTTO WORKERS COMP AUFORNIA- <br /> APPLICANT'S SIGNATURE: TTTL S . NG DATE <br /> EH 23 046(REV 7/10/92) <br />