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tvRItr aL tTtV <br /> SAN JOAQUIN LOEaLrB .tc1t 1PPLICINW. _of PERMIT -1 (� <br /> U1029GROUIID ?IN( t 1601 & HAIELTON 17E., STOCKTON Clt <br /> 1. CLOSURR 01 111NDOONSIT Telephone RM 463-3420 - r <br />.�a <br /> aex�t�t;�ta�txtt:t;�:�ezta�t��ost�e�t�t;�e�t>;r�st�stxe�t;�t�t;�te�tx�t�tx�e��tx�t;� <br /> I IPPLICITION FOR PERKINEIT/TEMPORIRT CLOSURE OR lBA1DONKENT IN PLACE OF UNDERGROUND 9111100US�SUBSTIICES STORAGE Ft%=-i4T <br /> ;HIS PERMIT EXPIRES 90 DAYS, FROM THE IPPROVIL DATE. 0o NOT TAITR I9 111 SHIT D AREAS. INDICATE PERMIT TYPE 16LOu' <br /> V R$M091L TEMPORARY CLOSURE _ 18II00KKE1T IN PLICS <br /> PROJEcr coI.T1Cr r; rELEPHDMg <br /> EPA SITE I Gp,,p 982-0591511 <br /> F FICILITT NIKE UNOCP-L_ -W�-:�,+8 pgalE 1 [2-0 9) <br /> A <br /> c IDORESS 3-7 <br /> I <br /> L CROSS ST119T K NY 2-0 A. <br /> I <br /> T oWHER/0P$H1TOR p• F::f,:'-PAU60K1 PHONE # � �\ X3(0 -a64 <br /> I <br /> C CONTRACTOR NAME (9i1a) 91'�a.-- r-2-- }- <br /> O .7.7 G�Rif=i��I C[ E uv AY <br /> S COITRICTOR 1DORESS 3 c7 <br /> C1 LIC # 3 7�{- ]� CLISS <br /> T rAI� 6P�K.5 l�P� . �.. <br /> I INSURER GyOL7SN �/�L�,L� SPI�1 �1t L-�C?� GA YORIC.COHP.t �;GGIv'Z�Ca�' <br /> 1 T�L`f mil L�FI2�. <br /> C FIRE DISTRICT PERMIT 111IS?TR �� v <br /> T 4 oN GST. X635-i�t3�) <br /> _ U <br /> 0 LIBORITORY 11ME 1 PHONE 1 <br /> R / r rsa-t✓ <br /> SIMPLINO FI&K' L.,ALII�c7NiA i�P.`CGt� SAMPLING manTSN 6010 <br /> y plaCy�I�CI s llD l cL NG-(8240),KrL7.�(iGP p tib} FGA- (a g-`1d i <br /> TANK ID II TIKI SIZE CHEMICILS STORED CURREXILT CHEKICILS STORED PRIIIIOUSL <br /> 1 39 <br /> [ 39- <br /> 39- <br /> 39- <br /> LIST 1DDITIOXIL TANK INFORMITION 11 ME°DSD ON SEPARITE FORK <br /> i I �90�1lfIID'1�19u�tl1�11311�11111�I�IIDI�lifU9 117�iIRl�'J�IitlJ�ll Ik' C"�1'I!L"�!�Ill�'WJLWi"�1�IWL'9".UL">119 '1�IIIL'@!ti'1f1�17i11�';iE?�19�t1�1Ullllff�19Wtuun11i�6�llq;�'sl�ll{D�:'Jililllllll�iClilFrllllJI�1QLIIIJI�11�11�'rd� <br /> P �^, APPROVED APPROVED WITH CONDITIONS _ DISIPPROYED I <br /> L ISE ITICBMENT ITH COYDITICNS) <br /> 1 ,PLAN REVIEYERS NINE DATE <br /> I . <br /> n � <br /> IPPLICINT MUST PERFORM ILL YORK IN ICCORDIMCE WITH SAN JOAQUIN COUNTY OROININCES, -STITE LIPS, AMC RULES IND REGUL1TIOUS <br /> OF THE SII JOAQUIN LOCAL HEALTH DISTRICT. OWNER 01 LICEIS80 AGENT'S SIGNITURE CERTIFIES THE FOLLOWING; 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE FORK FOR YHICM THIS PERMIT Iv ISSUED, I SHALL NOT EMPLOI 191 PERSON IN SUCH MANNER 13 TO SECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAYS OF CILIFORNIL' COMTRICTOR'S HIRING 01 SUECONTRACTING SIGNATURE CIIRTIFIES ?HE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMINCE OF THE 101.1 FOR WHICH THIS PERMIT 11 ISSUED, I SHILL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPEYSITION LAWS OF CILIFORYIA. <br /> CALL FOR INSPECTIONS AT LEAST 43 I•IOURS IN ADVANCE" <br /> JOHN !G?.ZGOIejN , F-OeEz-T 4.LIEF 1&15soc <br /> SIGNED - (tea L-rPNTs Fd�-UNOGPL� DATE r I / <br /> OFFICE dS9 OILY--lift 23 946 11/11 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS;SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS <br /> SFREPS 1 CORP # LOC CODE DIST C00 AMOUNT DUE 1X0 Ulf HCVD C11/CIS3 RCTO IT OLTE 100 PEINIT I, <br /> S <br />