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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> CLOSURE PERMIT <br /> THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br /> STORAGE TANK(S)EXPIRES 180 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE: <br /> LR REMOVAL 0 TEMPORARY CLOSURE 0 CLOSURE IN PLACE <br /> 777777i--' - 71 7 , <br /> EPA SITE#CAD982030207 PROJECT CONTACT Bob ]&jeo PHONE# 626189Q-7100 <br /> FACILITY NAME Union Pacific Railroad Stocktgn Yard ----RHONE# 916/789-5la4 jiM_)iel <br /> ADDRESS 833 E. 8th Street, Stockton, CA <br /> CROSS STREET <br /> OWNER OPERATOR Union Pacific Railroad _.22.Douj12Rjh.., Rm 1C HONE# 916/789-5184 Ji Diel <br /> mhay <br /> CONTRACTOR NAME United )2uMping Se-rvice, Inc. TPHONE# 6Z61961-9326 <br /> CONTRACTOR ADDRESS 14000 E.-Vailey Rl cal qtry.CA-TCALIC# 6]7632 CLASS A ASB HAZ <br /> INSURER Federal Ins, CgMapy WORKERCOMP# 0044727244 C21, C32, C42 <br /> FIREDISTRICT City of Stockton PERMIT 4 - - 4/30/15 <br /> LABORATORY NAME -re57- FI`yam,/CA COUNTY gq=,4- 1 PHONE# <br /> SA '-2�nd- r0'('L PHONEA <br /> A N- <br /> TANK ID# TANK SIZE TANK CONTENTS(PRESENT AND PAST) DATE INSTALLED <br /> 39- 3600 gal, oil unknown <br /> ,39 <br /> 30- <br /> D7 <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,FEDERAL LAWS,AND RULES AND <br /> REGULATIONS OF SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE <br /> FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH <br /> A MANNER AS TO BECOME SU$!Pl TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUBCONTRACTING <br /> SIGNATURE CERTIFIES THE F -LOWI43: "I CEPTIFY T)44T IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL <br /> EMPLOY PERSONS SUBJEC 0(70RK R'S CO I LAWS OF CALIFORNIA." <br /> APPLICANT'S SIGNATU -TITLEDATEI <br /> VDTION <br /> &J-01T N bf8-APP'R-'0VE-:bl <br /> �8 <br /> '(E <br /> (SEE ON IONS BEL <br /> OW.XNDIdR ON-ATTACHMENT). <br /> PLAN.REVIEWERS NAM <br /> DATE,- <br /> ANY DEVIATIONS FROWTHIS Aft"ATION MUST BE SUBMITTED TO EHD FOR APPROVAL PRIOR,TO COMMM N" A <br /> CI GWORK., <br /> CONDITIONS. . <br /> EH 23 046 (Revised 10/30/12) 3 <br />