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APPLICATIONFOR PERMIT SANSSA.� .. ."1J :.!IN.tnnN"!l�JS;^7x�rynnNnxnA��l1.k <br /> p � OAOULOCAL HEALTH DICTRICT 1 <br /> A UNDER 'IND TANK a 160h'04" ' <br /> VE., STO T A aO <br /> x, CLOSURE`W AL'ANDONMENT p 1, d 6 D��/(��� O <br /> A!IMGA!1N!7NiAlIAIIAN �./ <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT f O <br /> E T IN PLACE OF UNDERGROUND HAZARDOUS SUBSTAN, ST�F.�fl�t�'8� <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE 1N ANY SHADED AREAS. INDICATE PERMIT TYM!"89 <br /> ENVIRONMENTAL HEALTH <br /> __.X REMOVAL _____ TEMPORARY CLOSURE ABANDONMENT IN PLATE PERMIT/SERVICES <br /> EPA SITE t PROJECT CONTACT 6 TELEPHONE I <br /> F FACILITY NAME HEINZ PLANT PHONE 1 (209) 948-2782 <br /> A _ <br /> C ADDRESS 2800 S. California Street, Stockton, CA <br /> I <br /> L CROSS STREET El Dorado Street <br /> I <br /> T OWNER/OPERATOR. RJJ Trucking PHONE 1 <br /> Y 2431 Mariposa Road (209) 941-8361 <br /> Stodton. CA 95205 <br /> C CONTRACTOR NAME PHONE 1 (209) 462-9911 <br /> O Precision Industries Inc. _ <br /> N CONTRACTOR ADDRESS 1041 S. Pershing Avenue CA LIC 1 467293 CLASS A <br /> T <br /> R INSURER Ohio Casualty Croup WORK.COMPA WCW(89) 400-91-87 <br /> A _ <br /> C FIRE DISTRICT Stockton — PERMIT I/INSPTR <br /> 0 LABORATORY NAME Canonie Labs. PHONE 1 (209) 983-1340 <br /> R <br /> SAMPLING, FIRM* SAMPLING METHOD <br /> TANK 10 1 TANK SIiE CHEMICALS STORED CURRENTLY CHEMICALS STOPED PREVIOUSLY <br /> T <br /> A 3•j_ �� 3lf 12,000 Gallon _ diesel fuel n/a <br /> N 33 <br /> - ------------ — -- <br /> ---------------------------- <br /> Y. 19----------------------------- <br /> 33- <br /> ---------------------------- <br /> raMM2=®R , <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> P APPROVED APPROVED WITH CONDITIONS ___ DISAPPROVED <br /> L SEE ATTACHM T WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME DATE__ <br /> N -------------------- ----------------- ----------------------- - - ---------- <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER, OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 4B HOURS IN ADVANCE <br /> SIGNED--- - ----------------------------------------------------------------------------DATE - <br /> OFFICE USE ONLY <br /> fiiiiiffiftffffSitffSifi{fftffffifffffifftififfff{ffffSfffffiffffiffiifffffff{ififSffffffSffitfSfffSfffffSSfffftffSffffffS <br /> SWEEPS 1 i COMP I iLOC CODE iDIST CODEi AMOUNT DUE I AMOUNT RCVD ,f1;1/1'ASH RCVD BY DATE KCVO�, I PERMIT 1 <br />