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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br /> STORAGE TANK(S)EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE: <br /> S REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br /> FACILITY INFORMATION <br /> EPA SITE PROJECT CONTACT Erie Jenks PHONE# 916-991-4451 <br /> FACILITY NAME John Taylor Fertilizer (Wilbur-Ellis Co.) PHONE# 916991-9813 <br /> ADDRESS 1819 South Argonaut, Stockton, CA <br /> CROSS STREET Charter Way <br /> OWNER OPERATOR PHONE# <br /> CONTRACTOR INFORMATION <br /> CONTRACTOR NAME Ramcon Engineering&Environmental Contracting, Inc. PHONE# 916-372-7535 <br /> CONTRACTOR ADDRESS PO Box 1026, West Sacto,CA 95691 1 CA LIC# 510034 CLASS A az <br /> INSURER Gulf WORKER COMP-, 000713 0008215 ' <br /> FIRE DISTRICT City of Stockton PERMIT# <br /> y LABORATORY NAME CLS Labs COUNTY Sacto PHONE* 916-638-7301 <br /> 'J SAMPUNGFIRM abs PHONE # - - <br /> TANK INFORMATION <br /> TANK ID# TANK SIZE TANK CONTENTS PRESENT& PAST DATE INSTALLED <br /> 39- Unknown 12,000 Gal Split: Sk Gas/4K-Diesel 92 or 93 <br /> 39- <br /> 39- <br /> 39- <br /> 39- <br /> 139- <br /> APPLICANT <br /> 9- <br /> 39-3939- <br /> 39-APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES.STATE LAWS.FEDERAL LAWS,AND RULES MID <br /> REGULATIONS OF SAN JOAOUIN COUNTY PUBLIC HEAL74 SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 1 <br /> CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS <br /> TO BECOME SUBJECT TO WORKERS COMPENSATION LAWS OF CAUFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKER'S COMPENSATION LAWS CJF CALIFORNIA.' <br /> APPLICANTS SIGNATUR TITLE Operations Manager DATE 1-29-03 <br /> It <br /> ❑APPROVED APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br /> (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> PLAN REVIEWERS NAME/VWI(Yl. (ffbkR DATE44 <br /> -p3 <br /> ANY DEVIATIONS FROM THIS APPLICATION MUST BE SUBMITTED TO END FOR APPROVAL PRIOR TO COMMENCING WORK. <br /> CONDITIONS: <br /> Sep l�f�itt.t�l �?rt� u�i�/�h Q Grsf- 0� <br /> EH 23 048(REVISED 08113199) - Page 3 <br />