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Sent,By; RHL DESIGN GROUP; 7077656835; Dec -22-98 4;05PM; Page 2 y/Y8/88 FRI 09:30 FAI 5108080" REL DESIGN GROUP RRL PUTALUNA fQ004 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DMSION APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT ,r-- THIS PERMIT FOR PERMANENTREMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDER MUND HAZARDOUS SUBSTANCES STORAGE TANK(S) EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SJiADED AREAS. INDICATE PERMIT TYPE K REMOVAL O TEMPORARY CLOSURE ❑ CLOSURE IN PLACE APRICAJTT MUST RryRFOMM ALL WORN MACCORDAMM MILAN MN JOAGUN OOUMY ORONMDES, eTATE LAWS. MAML LAV 4. AND RULES AND REGULATIONS OF SAN JOAQUN COUNTY PUNJC HEALTH SERVICES OWNER OR UceaW AGENTS SK?UTURE CENWES TIRE FOLLatio : •I CERTIFY TUT N THE PERFORMANDE OF THE W OM FOR VA40H TRIG PERMIT IS ISSUED. I DIAL MOT EMPLOY ANY PlRSLRJ N SUCH A MVWT■R AS TO BECOME SUBJECT TO WORKERS COMPENSATION LAWS OF CALIFORNIA' CONTRACTORS HIRELG OR SUBCONTRACTING SIGNATURE CEATIPM5 THE FOLLOWING: 'I CERTIFY THAT N THE PERFORMW-6 OF THE WORK AOR WINCH THIS PERMR 13IBSUED. I SHALL EMPLOY PERSONS SUBJECT TO WORKERS COMPENSATION LAMS OF.CALWORNN' _ APPLICANTS SIGNATURE /I LGf/ _/+Pifl - TMI T r01eGA ol!nUe� DATC Z ` l •t) � s�� d • - • •• f • f • ■ f • f {! / / L• t m CONDITIONS: _ / � - FACILITY INFORMATION CONTRACTOR INFORMATION EPA SITEr c t Dooidol PROJEa CONTACT SYt T -r Rou wAmo PHONES 4Z -157-1445 FACILITY NAME ADDRESS A.1 S µd 1313 E • Ckarier A PHONE r O- ti V - Y 1 CROSS STREETOkla-pboLT Vlore FIRE DISTRICT 5TocitTw 'F.Rr-PEFV+IT LABORATORYNAME SERLAONa OWNER OPERATOR 1 r- C7•YA PHONE I Z CA - - M O I APRICAJTT MUST RryRFOMM ALL WORN MACCORDAMM MILAN MN JOAGUN OOUMY ORONMDES, eTATE LAWS. MAML LAV 4. AND RULES AND REGULATIONS OF SAN JOAQUN COUNTY PUNJC HEALTH SERVICES OWNER OR UceaW AGENTS SK?UTURE CENWES TIRE FOLLatio : •I CERTIFY TUT N THE PERFORMANDE OF THE W OM FOR VA40H TRIG PERMIT IS ISSUED. I DIAL MOT EMPLOY ANY PlRSLRJ N SUCH A MVWT■R AS TO BECOME SUBJECT TO WORKERS COMPENSATION LAWS OF CALIFORNIA' CONTRACTORS HIRELG OR SUBCONTRACTING SIGNATURE CEATIPM5 THE FOLLOWING: 'I CERTIFY THAT N THE PERFORMW-6 OF THE WORK AOR WINCH THIS PERMR 13IBSUED. I SHALL EMPLOY PERSONS SUBJECT TO WORKERS COMPENSATION LAMS OF.CALWORNN' _ APPLICANTS SIGNATURE /I LGf/ _/+Pifl - TMI T r01eGA ol!nUe� DATC Z ` l •t) � s�� d • - • •• f • f • ■ f • f {! / / L• t m CONDITIONS: _ / � - �f�! moi■ CONTRACTOR INFORMATION A a � _�/u_�� i � i CONTRACTOR NAME CONTRACTOR ADDRESS 1400 IE Ri is 4 n IPHONE 0Lp <cm%qWtWJ 1LOwIL I a LIC s 2 f 91;-m It 6-'65Se ;700 1 cuss A6 N s ENSURER IZL k t RKBIGOMPf W99A 1469D I FIRE DISTRICT 5TocitTw 'F.Rr-PEFV+IT LABORATORYNAME SERLAONa r (1 r.Ij I COUKTV S, TV1a}e .. TRoNEs (-S0-36Y- boo SAMPLI Fl w�it'iN tpnVllrF�iVitn'ir�. PHDNE • lq 3 L - APRICAJTT MUST RryRFOMM ALL WORN MACCORDAMM MILAN MN JOAGUN OOUMY ORONMDES, eTATE LAWS. MAML LAV 4. AND RULES AND REGULATIONS OF SAN JOAQUN COUNTY PUNJC HEALTH SERVICES OWNER OR UceaW AGENTS SK?UTURE CENWES TIRE FOLLatio : •I CERTIFY TUT N THE PERFORMANDE OF THE W OM FOR VA40H TRIG PERMIT IS ISSUED. I DIAL MOT EMPLOY ANY PlRSLRJ N SUCH A MVWT■R AS TO BECOME SUBJECT TO WORKERS COMPENSATION LAWS OF CALIFORNIA' CONTRACTORS HIRELG OR SUBCONTRACTING SIGNATURE CEATIPM5 THE FOLLOWING: 'I CERTIFY THAT N THE PERFORMW-6 OF THE WORK AOR WINCH THIS PERMR 13IBSUED. I SHALL EMPLOY PERSONS SUBJECT TO WORKERS COMPENSATION LAMS OF.CALWORNN' _ APPLICANTS SIGNATURE /I LGf/ _/+Pifl - TMI T r01eGA ol!nUe� DATC Z ` l •t) � s�� d • - • •• f • f • ■ f • f {! / / L• t m CONDITIONS: _ / � - �f�! moi■ TANK INFORMATION A a � _�/u_�� i � i TANK ID r TAWS TANK CONTEWS ( a PASTI I LUTE LNSTALLED 39 13,17777 1b, 001D CTA-kot.14% �s /- t913 39- 19,000 97 39-; 0.000 !a^sa W& 39- 39- 38- APRICAJTT MUST RryRFOMM ALL WORN MACCORDAMM MILAN MN JOAGUN OOUMY ORONMDES, eTATE LAWS. MAML LAV 4. AND RULES AND REGULATIONS OF SAN JOAQUN COUNTY PUNJC HEALTH SERVICES OWNER OR UceaW AGENTS SK?UTURE CENWES TIRE FOLLatio : •I CERTIFY TUT N THE PERFORMANDE OF THE W OM FOR VA40H TRIG PERMIT IS ISSUED. I DIAL MOT EMPLOY ANY PlRSLRJ N SUCH A MVWT■R AS TO BECOME SUBJECT TO WORKERS COMPENSATION LAWS OF CALIFORNIA' CONTRACTORS HIRELG OR SUBCONTRACTING SIGNATURE CEATIPM5 THE FOLLOWING: 'I CERTIFY THAT N THE PERFORMW-6 OF THE WORK AOR WINCH THIS PERMR 13IBSUED. I SHALL EMPLOY PERSONS SUBJECT TO WORKERS COMPENSATION LAMS OF.CALWORNN' _ APPLICANTS SIGNATURE /I LGf/ _/+Pifl - TMI T r01eGA ol!nUe� DATC Z ` l •t) � s�� d • - • •• f • f • ■ f • f {! / / L• t m CONDITIONS: _ / � - �f�! moi■ (>•��.• Y Thi' � /I � � .A A a � _�/u_�� i � i EH Z10A6 (R IOnBJ9e) FW4