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r t' * 1• <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND TANK CLOSURE PERMIT 000146 <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT <br /> IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK. <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. <br /> DO NOT WRITE IN ANY SHADED AREAS.INDICATE PERMIT TYPE BELOW: <br /> (_REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br /> EPA Site# Project contact&Telephone# <br /> F CA2890090002 C.Susi Jackson 510 423-6577 <br /> A Facility Name Phone# <br /> C Lawrence Livermore National ,Site 3001(510)423-4981 <br /> I Mailing Address:7000 East Avenue,P.O.Box 808,Livermore,CA 94550 <br /> L Site Address Corral Hollow Road south of Trac <br /> I Cross Street <br /> T located 15 miles east of Livermore on Corral Hollow Road cen Tesla Road and Highway 580 <br /> Y Owner/Operator:U.S.Government-Departrnent of Energy, Phone# <br /> Universityof California 510 423-6577 <br /> Phone# <br /> Contractor Name y Os" f S3'{� <br /> C <br /> O Contractor Address t CA Lic# Class <br /> Oa.9� pl <br /> N c0SCprn Sca .�Si. <br /> T Insurer Work.Comp.# <br /> R Z S. IP 0® <br /> A Fire District Pemnt# <br /> C LLNL Site 300 Fire 20aMent <br /> .I Laboratory Name Phone# <br /> O Cia on Environmental Consultants 510 426-2600 <br /> R Sampling Firm Phone# <br /> LLNL,Environ anion nt 510 423-6577 <br /> Tank ID # Tank Size Chemicals Stored Cnrrentl /Previonsl Date UST Install <br /> 39- 280 tons diesel fuel Unknown <br /> T 39- <br /> A 39- <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> P Approved Approved with Condition(s) Disapproved <br /> L (See At hment with Conditions) <br /> A <br /> N Plan Reviewers Name Date <br /> APPLICANT MUST ALL WORK IN ANCE WITH SAN lOFVK <br /> COUNTY ORDINANCES <br /> STATE LAWS.AND <br /> RULES AND REGULATIONS OF SAN JOAQUIIJ COUNTY PUBLIC I�Ai-THFS.OWNER OR LICENS®AGENT'SSIGtiATURE CERTIFIES THE FOLLOWING: I CERTIFY THAT IN THE PERNCE OFTHE WORK FOR WHICH THIS PERK T <br /> LS;&SUED.I SH/C tiOT EI-SPLDY ANY PERSON IN SUCH A MANNER AS TO BECOME SliBJECtTO WOR CMS COMPE.NSATIO'; <br /> LAWS OF CALIFORNIA.' CONTRACTORS HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOL.OAING: -1 <br /> CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT LS ISSUED.I SHALL EMPLOY PERSONS <br /> SUBJECT TO WORKERSALIFORNTA._ <br /> APPLICANTS SIGNATURE: TTTL n1G DATE 10 IC13— <br /> JOEEH 23 046(REV 7/10192) <br /> 3 <br />