Laserfiche WebLink
VOW <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br />THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PUCE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br />EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br />X REMOVAL _ TEMPORARY CLOSURE CLOSURE IN PLACE <br />CONDITION(S)I / ,wY Cn (1 n <br />1 L.L.,,,�c.vwar10.1L�sy`" <br />EN 23 046 (Revised 9/11/%1 Page 3 <br />EPA SITE IT CAC 001357712 <br />PROJECT CONTACT 6 TELEPHONE N Jim Thorpe Oil , Inc. (209) 368-6175 <br />F <br />FACILITY NAME Stockton Metro litan Airport <br />PHONE M <br />Ac <br />ADDRESS 5000 S Airport Way, Stockton, CA 95206 <br />L <br />I <br />CROSS STREET Northrup Rd. and Longe St. <br />T <br />OWNER/OPERATOR <br />PHONE B <br />Y <br />The County of San Joaquin, Dept. of Aviation <br />(209)468-4700 . <br />C <br />0 <br />CONTRACTOR NAME Jim Thorpe OT I , -Inc. <br />PHONE B (209) 368-6175 <br />N <br />T <br />CONTRACTOR ADDRESS p. 0. Box 357, Lodi, CA 95241 <br />CA LIC s 495699 <br />CLASS A, B, Haz. <br />R <br />INSURER Firemans Fund/GenstarWORK.CONP.M <br />007197-97 <br />A <br />CFIRE <br />T <br />DISTRICT Montezuma. <br />PERMIT / upon approval <br />0 <br />LABORATORY NAMEGeoAnal,ytical Labs <br />COUNTY San Joaquin <br />PHONE B (209) 572-0900 <br />R <br />SAMPLING FIRMGG @1 'cal <br />111111 I lllll <br />TANK ID <br />Laboratories <br />PHONE 0 (209) 572-0900 <br />�(R <br />3,0MKbi!lon8 <br />CHEMICALS CURRRENTLY/PREVIOUSLY DATE INSTALLED <br />39- <br />gS1TOREoa <br />ine <br />T <br />39- <br />, gallons <br />vasoline uk <br />A <br />39- <br />N <br />39- <br />K <br />39- <br />39- <br />39- <br />P <br />1111111111111111 fill 1111111111111111111 11111111 MTmwffffffwlTr <br />L <br />APPROVED APPROVED WITH CONDITION(S) DISAPPROVED <br />A <br />(SEE CCT BELOW AND/OR ON ATTACHMENT) <br />N <br />PLAN REVIEWER'S NAMEDATE / <br />11111111111111111111111 fill <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "1 CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br />011 <br />CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA." ' <br />APPLICANT'S SIGNATUREo TITLE Contractor/Agent DATE //.J- :Y9r <br />CONDITION(S)I / ,wY Cn (1 n <br />1 L.L.,,,�c.vwar10.1L�sy`" <br />EN 23 046 (Revised 9/11/%1 Page 3 <br />