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SrL,N JOAQI.IN COLi4TY PUBLIC HEALTH SERVICES <br /> E vjROjNr'c% 'NTAL BEALTH DIVISION <br /> A-PPLICATION FOR UNDERGROUND STC RAGE TzkINK CLOSURE PERMIT <br /> TriE ?ERMII FOR PERMANENT/?EXPCR.ZY C SURE CR'AS-NDCNMENT IN PLACE OF UNOE.RGRCL'HD HAZARDCUS SUBSTiANCE STCRAGE TANK <br /> cXPIRES 9D DAYS FRCM THE APPROVAL D iE. ' DO NOT VR!TE iN ANY SHADE' AREAS, ING:CATE PERMIT TYPE oELCJ: <br /> 4E"CVAL TE,'!PCRARY CLO URE CSURE IN PLACE <br /> `PA :iiE Y � j � I PROSECT CC.kT„CT 3 T __ .CNE IEP ; T Bill Little @ 209-956-0264 <br /> � r <br /> i =AC!LITY .qA>,� <br /> PHONE T 466-7223 <br /> c ACORESS 345 Yosemite Avenue, Stockton, Ca 95204 <br /> I <br /> FremonY Street <br /> Nass STREETI <br /> i C O en 1 as PxCHE 4 <br /> T C4HEi/CPE.AA16n%/n Sate Deposit Bank PO 1200 S4?�6�on Ca.� <br /> 209-946-5050 <br /> cc RAC�CR NAME,� Advanced GeoEnvironmental I 9f4CNE s 209- 956-0264: <br /> 4 � N I <br /> 3 west March lane STK CA I CA L:C 680227 <br /> ADDRESS ct ss <br /> N CC'iTa C"C2 I A HaZ € <br /> .NSLRE.R Dealy, Renton and Asscts - RP 066 223 I 'rcRz,cUw,P,: 1317474-96 <br /> ''- i , Stoc ton Fire Prevention �Gzy <br /> [T <br /> FIRE �ISTR:C : I <br /> .0 LASCRATCRY .NAME Mc Campbell Con tra Costa E 7iCNE T 510 798-1 620 <br /> � ' kHthi�fk_IItI�Ii E I r Y <br /> ,ANr ID r 4, OOeNgailon I :;silt Ls sTcgaso in e/PR 'rlct� <br /> I 9 <br /> C 39- I <br /> .9- <br /> llllllililllllllliiififlllllll liiiiE[lllili11111 illlillllll11111111Ellllitlllilllillli]1111111111i1f1Iil11111I1i'111if1111' <br /> 3 <br /> L APPROVED APPRCVED WITH CC C1iTiCN(S) DISAPPROVED' 7 <br /> �a <br /> � A ($cc CCN17I7;C45 BELOW 'ND/CR CN AT'ACHN.ENT) <br /> .N <br /> =1_.;N REV --%E ER IS NAME GATE <br /> � 11111I1111IIIIIIIII[III[II11fIlIIIIIEI1i11111I1IlI1II1lIlIII1IliI IIIIlllllilIltllfi111IIIIIIIl11IIiiIiIIIIIIIIIIiIfl11I11III , <br /> ,:PPI_1CANT '!UST PERFCRH ALL '=CRK IN :,CCCRCAHC; WITH SAH :CACU[N CCUN Y CRDINAHCcS, STATE LAWS, AND 3UL.S AND RE-CL.LATiCNS OF � <br /> SAN :CACUIN CCUU TY PUBLIC XEALTH SERVICES. OWNER CR LIC'-NSED AGENT'S SIGNATURE CERT M ES THE fvLLC.JING: "1 CERTI^! THAT iN - <br /> { <br /> THE - <br /> OF THE 1CRK FCR 4HICH THIS ?ERM17 IS iS5 'c], I SIAL NOT E:iPLOY ANY PERSCN IN SUCH A MANNER AS TO iE:wME <br /> SUSjECT TC '.'CRKER'S CCMPENSAT1CH LAWS OF CALiFCRNIA." C_NiZACiCR'S :TIRING CR SUBC.^•NTRACTiNG SIGNATURE CERTIFIES THE FaLLCJiNG:I <br /> "! CERTIFY THAT IN THE PERFCRKANCZ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SVALL EY.PLOY PERSONS SUSjEr- TO ::CRKER'S <br /> CCMPENSAT[CH CANS OF CALIFCRNIA." <br /> 7-R <br /> APPLICANT'S S;GNATURE: TITLE DATE <br /> CONDMON(S): <br /> Z , <br /> :.y ��erisec' 7/1D/9� Page .3 <br />