Laserfiche WebLink
A, .", .^. .".':..^2n.".::a."a«."a: <br /> APPLICA- '4 FOR PERMIT p SAN JOAQUIN LOCAL HEALTH TRICT a �� <� , <br /> i O p <br /> OSURE . 'IND TANK 1601 E iEl ON AVE., STS 1 A CLOSURE �. ACANDONMENT „ �1�� �� � D �n <br /> aaraaaaaaa«a««uusuar.««auraaM.aaMaaa .. aaaaauuup;rau;maubuua,i.aauaa o <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTAN, ST�F.��t II��q <br /> THIS PERMIT EXPIRES 30 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TY pO�q <br /> __.X REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE ENVPERNIIMENTALIHEALTH <br /> EPA SITE I PkOIECT CONTACT f TELEPHONE I <br /> F FACILITY NAME HMZ 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 /> 1 <br /> T OWNER/OPERATOR, 13JJ Trucking PHONE I <br /> Y 2431 Mariposa Road <br /> Stockton. (209) 941-8361 <br /> C CONTRACTOR NAME TCA <br /> E 1 (209) 462-9911 <br /> O Precision Industries Inc. <br /> N CONTRACTOR ADDRESS 1041 S. Pershing Avenue IC 1 467293 CLASS A <br /> T <br /> R INSURER Ohio casualty Group .COMPA TOM(89) 400-91-87 <br /> _ <br /> C FIRE DISTRICT Stockton — PERMIT I/INSPTR <br /> T <br /> 0 LABORATORY NAME Canonie Labs. PHONE 1 (209) 983-1340 <br /> R <br /> SAMPLING FIRM* SAMPLING METHOD <br /> TANK 10 1 TANK SITE CHEMICALS STORED CURRENTLY CHEMICALS STOPED PREVIOUSLY <br /> T <br /> A 33 __�D 3`/_- 12,000 gallon _ diesel fuel n/a <br /> H 33- -------- - — <br /> K 33 <br /> ---------------------------- <br /> 33 <br /> ---------------------------- <br /> 33 <br /> ---------------------------- — - <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> P - APPROVEDfis <br /> APPROVED WITH CONDITIONS DISAPPROVED <br /> L <br /> EATTACHM T WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME <br /> N - - - -- - DATE__I -lO=M <br /> mu <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 WORE: 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 48 HOURS IN ADVANCE <br /> SIGNED ------------------------------------------DATE <br /> ------------------------------------------ <br /> OfFICE USE OMIY ........................... <br /> fiiifffffifl{Ififfifffffffftfftfiffis$its iffiffff{fflfffiffffitffftffiifffftS{if ififffffffftfiiffttfftffffffftfftfffffffff <br /> SWEEPS I ' COMP I 'LOC CODE '01ST CODE' AMOUNT DUE i AMOUNT 9.00 ' CKII/CASH RCVD BY DATE KCVO I PERMIT 1 <br /> - ao. � - - ►- q-�J - ---- <br />