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Xerox Tei'eoopier 7021 , 12-94 ; 9:01AM ; 1 <br /> 9163811622;" 4 <br /> ' Gni <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND TANK CLOSURE PERMIT <br /> APPLICATION FOR PER'viANEN-17 -7NIPORARY CLOSL`RE OR ABANDONMENT <br /> N PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK. <br /> THIS PERMIT E.XPMS 90 DAYS FROM THE APPROVAL DATE. <br /> DO NOT WRITE IN ANY SHADED AREAS.INDICATE PERNUT TYPE BELOW: <br /> —.2L—RPM1—OVATBIvIPORARY 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 Lvernore National Laboratory JLnj Site 300 1 (510)423-4881 <br /> I Mailing Address: 7000 East Avenue,P.O.Box 808,Livermore,CA 94550 <br /> L Site Address: Corral Hollow Road south of Tracv.CA 94550 <br /> I Cross St est <br /> T located 15 Miles east of Livermore on Corral Hollow Roallbetween Tesla Road and Highway 580 <br /> Y Owner/Operator:U. S.Gover=ent-Department of Energy, Phone# <br /> Lriversity of C'.alifornla 510 423-6577 <br /> Contractor Name Phone# <br /> C ARONSON ENGINEERING INCORPORATED 916-381 -1600 <br /> 0 Cont-a.:or Ad:rens CA Lic# Class <br /> N 6809 McComber Street 1 Q _ <br /> T IGS:II'Cr Work. Comp. # <br /> R Golden Eacrle Insurance Cornnal2y PWC 38 71 <br /> A Fire Distict Permit# - <br /> C LLNL. Site 300 Fire De artrnent <br /> T Laboratory Na=e Phone# ' <br /> 0 California Laborato •Seniccs 916 638-7301 <br /> R Sampling "Fir= Phone <br /> LLN'L. Envirormen al Protection De =nnent 5 1 Q 423-4012 <br /> Tank ID # Tank Size Chemicals Stored Currentiv/PreviOLSI Date UST Instal.ledl <br /> 39- / 2 y / 2.000 zallons diesel fuel 1982 <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 Attachment with Conditions) <br /> A <br /> N Plan Reviewers Name 6L&z2zV Date <br /> APPLICANT MUST PFiniLm ALL WORK IN ACCORDANCE SAN JOAQL'L*N COLWN ORDINANCES,STATE LAWS,AND <br /> RULES AND UGULATIONS OF SAN JOAQUIN COUNTY PUBLIC id SERVICES. OWNER OR LICENSED AC1S',M <br /> SILNA.TLRE=- FIEi S TIM FOLLOWING- "I CMRTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WICCH THIS PE Lv= <br /> IS ISSL'=,I SHALT.NOT Y ANY PERSON IN SUCH A MAT`T'ER AS TO BECOME SLBJBC'I TO WORKER'S CO.�'E'ySATTON <br /> LAWS OFCM\ - CO..N TRACIUR'S HIRING OR SLBCOVMACTNO SIGNATURE CERTIFIES THE FOI1.0 C'r "I <br /> C'ERTTY THAT LN THE FMMRMANCE OF THE Won FOR WHICH THIS pMLWT IS ISSUED.I SHALL M TLOY PERSONS <br /> SLWECTTO WORKER'S COMPSNSATIO.'LAW F RNLA." <br /> APPLICA_N'TS SIGNATURE: TITLE Vice Pres ATE 1 <br /> IrH 23 0``46 V 7/10/92) �.,��a� ��✓� l 1 G{i Z <br /> (U �J_ <br />