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t"tt ttttttttti'ti ti'Ct Cit tt N'tttt tx tttt!ttt tt It It Yttt telt ttttIT.tt tttt <br /> r APPLICATION POR PERMIT F SIN JOAQUIN LOCAL HEALTH DISTRICT t: <br /> ! <br /> UNDERGROUND tANI r 1601 B NAIELTON AIR., STOCIT01 Cit <br /> r CLOSURE OR II1N00IMBll f Telephone (2091 168-3120 <br /> e <br /> V1111:11 ltttttttttettttttIt:ttttttn ttttttktttttttttttttn tttttttx tt <br /> IPPLICITION FOR PBRMANBIT/TtMPORIRr CLOSURE OR ABAIDONNENt IN PLACE OF UNDERGROUND MAIIRDOUS SUBSTINCES STORAGE FACILITY <br /> THIS PERMIT BIPfIRS 90 DAYS FROM THE IPPROVIL DATE. DO NOT 11118 IN 111 SHADII AREAS. INDICATE PERMIT TYPt IBLOV: <br /> -- RINOTAL _XX_ TBNPORARY CLOSURE — 1811DOMMENT IN PLICI <br /> EPA SITZ 1 HONE 1 PROJECT COPTIC? A TELEPHONE CAD -9708$9142 _ x111 Iblatt <br /> P PdCfLITf NAME <br /> APHONE I (20 <br /> C ADDRESS - A-15339 __ <br /> _fIA W11311 <br /> L CROSS STl11T <br /> IMellon Axamm <br /> T OVNII/OPIRItOR <br /> PRONE 1 <br /> r <br /> C COITIICIOR RAMI <br /> O Axantl1rans, PRONE 1 <br /> I COITRICTOR IDDRBSS Cl LIC 1 <br /> T A 7 CLISS <br /> 1 _ IORK.COMP.1 <br /> C PIRG DISTRICT <br /> T - Han IF PERMIT 1/IISFIR <br /> 0 L/BORITOIT IAMB -2ola� <br /> p --- Ttaca Ana1TaL PRONE I <br /> K413j 783-6960 <br /> SAMPLI/G FIRM, SIMPLING MET100 <br /> B�RN.eIIa amc E <br /> TINT ID 1 <br /> T Tlll SITE ((;al.) CHEMICALS STORED CURRENTL CHEMICALS STORED PRBVIOUSL <br /> 1 39 _ t 2 300 <br /> 1 5Q0 <br /> 1 39- <br /> J9--- <br /> 39Nnone <br /> -100 e — -&M----- <br /> 932 U2904 <br /> LIST <br /> &4N -- <br /> LIST ADDITIONAL TANK INFORRITfON AS NEEDED 01 SEPARATE FORK <br /> tl1�Y11 <br /> P IpItRtNtA�piR <br /> APPROVED IPPROVBD PITH CONDITIONS _ DISAPPEOVED <br /> A PLAN RE1ItItRS NINE (SBR /TTACNMEYT PITH CONDITIONSI <br /> I —' -- -----DATE----- <br /> IPPLIC <br /> go, <br /> OF <br /> SA MUST UINPLOM ILL ALIN II TRICTDINCE 11TH Sig JOAQUIN COUNTY ORDINIICES, STATE LIPS, AND RULES IND REGULITIONS <br /> OF ANE SAN JOAQUIN LOCAL NLILTH DISTRICT OWNER OR LICLISED AGIN" SIGIITURB CERTIFIES THE FOLLOWING: if CERTIFY THAT <br /> IN THE PERFORMANCE OF TNB PORE FOR YBICN THIS PERMIT IS ISSUED, I SHILL NOT EMPLOY III PERSON INITISUCH MIVMRR AS TO BECOM <br /> SUBJtCT TO IORKIR'S COMPEISON LIPS OF CILIFORIfA.' CONTRACTOQ'S BfRIIG OR SUBCOYTBdCT(NC SIGNATURE CBRTIP1THE <br /> VOLLOYIIG: 91 CEQTIIY TNdT 11 ?HE PER PORN/NCB OP TH8 'ORI POR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJFC <br /> TO YORKER'S COMPENSATION III$ OF CIL110/111. <br /> CALL FOR INSPECTIONS AT LEAST 40 HOURS IN ADVANCE , <br /> IGHBD 7 SII <br /> Oi'FICE USE ONLY-1H 1) IIA �12/11 _'_`--- <br /> SSSSSSSSSSSSSSSSSSSSS99SSSSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSsSSSSSSSSSSSSSSSSSISSsS <br /> YELPS 1 COMP i <br /> =ST C00 (MOUNTAMOUNT RCVD CII/GASB RCVD BY DATE RCVD PERMIT II I <br /> — b�$ <br />