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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 PLACE 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 Remove 10 fti <br /> pipe <br /> if necessary _ REMOVAL _ TEMPORARY CLOSURE _ CLOSURE IN PLACE <br /> EPA SITE # PROJECT CONTACT 8 TELEPHONE # <br /> 1 ell 415 742-6337 <br /> F FACILITY NAME USPS Stockton VM PHONE #(209)A <br /> ADDRESS 983-6316 <br /> 3131 Arch Road Stockton <br /> L CROSS STREET <br /> I Highway 99 <br /> T OWNER/OPERATOR <br /> Y US Postal Service PHONE # i <br /> (415) 742-6337 <br /> C I CONTRACTOR NAME GHH Engineering, Inc. PHONE #(916)723-7645 <br /> (916)723-7645 <br /> N CONTRACTOR ADDRESS CA LIC # <br /> T 1 5329yi CLASS 21 Z <br /> R INSUFIRE DISTRICT N/A <br /> Specialty Insurance CO. WORK.COMP.#WZP807 <br /> A <br /> C FIRE DISTRICT N/A <br /> T PERMIT # <br /> 0 LABORATORY NAME S OidAnal lcal COUNTY PHONE # <br /> R Sacramento (916) 921-9600 <br /> SAMPLING FIRM URS Greiner PHONE # <br /> IIIIIilllllllllllllllllllll (415) 774-2700 <br /> TANK ID # <br /> 39- <br /> TANK SIZE I CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> T 39- 12,000 C,al l On col i ne <br /> A 39- 12.000 ra 1 1 on T.ese <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> P IIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIillllllllllllllllliillllll Illllllllllllllllllllllllf III 111111 IIIII1111111111111111 <br /> L APPROVED APPROVED WITH CONDITION(S) DISAPPROVED <br /> A (SE CONDITIONS BELOW AND/OR ON ATTACHMENT) Q p� <br /> N _ ! O <br /> PLAN REVIEWER'S NAME /� DATE <br /> 11111111111111111111111111 Iilllllllllilllllllllllllllll I II 111111111111111111111111IIIIIIIIIIII11111111111111111111111111 <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: "I 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 /> "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORNIA." <br /> APPLICANT'S SIGNATURE: TITLE DATE <br /> CONDITION(S): <br /> EH 23 046 (Revised 9/11/96) Page 3 <br />