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3-01-1999 2:43PM FROM P_d <br />r • <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br />THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br />STORAGE TANK(S) EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INOICATE PERMIT TYPE. <br />Cl REMOVAL <br />❑ TEMPORARY CLOSURE M CLOSURE IN PLACE <br />HOLY SUGAR CONTRACTOR INFORMATION <br />FACILITY INFORMATION <br />CONTRACTORNAME EMPLOYEES WILL BACK FILL <br />EPASITE# CAD081367791 I PROJECTCONTACT ANNE OGREY <br />PHONE0209-835-3210 <br />FACILITY NAME HOLLY SUGAR dba <br />SPRECKELS SUGAR COMPANY <br />- - <br />PHONE # 209-835-3210 <br />ADDRESS 20500 HOLLY DRIVE <br />ADDRESS <br />- TRACY, CA 95376. <br />A <br />CROSS STREET ARBOR DRIVE <br />PERMIT# N <br />OWNER OPERATOR HOLLY SUGAR <br />COUNTY FRESNO <br />PHONE# 209-835-3210 <br />HOLY SUGAR CONTRACTOR INFORMATION <br />CONTRACTORNAME EMPLOYEES WILL BACK FILL <br />UNDERGROUND VAULT <br />PHONE# 209-835-3210 <br />CONTRACTOR ADDRESS 20500 HOLLY DRIVE — <br />TRACY, CAGa LIC# <br />N/A CLASS N/A <br />INSURER N/A <br />WORKER COMDR N <br />A <br />PIREDISTRICT TRACY RURAL <br />PERMIT# N <br />LABORATORY NAME APPL LABS FRESNO <br />COUNTY FRESNO <br />JPHONE# <br />SAMPLING FIRMJOHN MINNEY ENGINEERING <br />I PHONE 559-275-5937 <br />TANK INFORMATION <br />TANK ID # TANK SIZE TANK CONTENTS (PRESENT & PAST) DATE INSTALLED <br />39- TA504840 10,000 GALLON BUNKER C FUEL OIL PRIOR TO 1969 <br />39- <br />39- <br />39- <br />39- <br />39 - <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 PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENTS SIGNATURE CERTIFIES THE FOLLOWMG. 'I <br />CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS <br />TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br />THE FCLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL EMPLOY PERSONS SUBJECT TO <br />WORKER'S COMPENSATION LAWS OF CALIFORNIA' <br />APPLICANTS SIGNATURE_PC&( TITLE 144t4� e!f��OATE 3 ` 11 y4 <br />❑ APPROVED ❑ APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br />(SEE CONDITIONS BELOW ANOIOR ON ATTACHMENT) <br />PLAN REVIEWER'S NAME DATE <br />ANY DEVIATIONS FROM THIS APPLICATION MUST BE SUBMITTED TO END FOR APPROVAL PRIOR TO COMMENCING WORK. <br />CONDITIONS.- <br />MPR <br />ONDITIONS: <br />MPR 01 199 14:53 PAGE.04 <br />