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)I UNDE.kt,kUUND TANK II ljjjLV11 0 '�j�L, I'U&AWYe" STOCKTON CA II <br /> CLOSURE OR ABANDONMENT ttTc''1 �tt'Qt1IC �•09 ) 9 f,8-3 4 2 H <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONNSNT IN ?LICE OF UNDERGROUND BAKARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IB ANY SNIPED AREAS. INDICATE PERMIT TYPE BELOW: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> a F� PROJECT CONTACTI PHONE # 2_0�_/ <br /> A A L- (� U-) L <br /> C FACILITY NAME ADDRESS 3534 <br /> _.. <br /> L OWNER ADDRESS <br /> I - --- A. L, owC� Z35F �Q' ►Q_, ..ESL'E4�ALU_ <br /> T j CROSS STREET I PHONE # .�/ gaff — 747cD <br /> Y <br /> 1 <br /> Il_JL--- <br /> 0 CONTRACTOR NAME T PHONE # / <br /> N I CONTRACTOR ADDRESS CA LIC # <br /> R LIC CLASS WORK . COMP . # INSURER <br /> A —____--___.-_ 1: __- -. _ <br /> C FIRE DISTRICT /� T PERMIT # <br /> 0 LABORATORY NAME PHONE # / 5Z 7- C.}OSQ <br /> If <br /> R --- --- -- - 5*41jQ2JJIR -, <br /> . .._ <br /> SAMPLERS NAME l SAMPLING METHOD <br /> I WooC VOLUME CHEMICALS STORED l DATES STORED CHEMICALS STORED <br /> H ID N CURRENTLY PREVIOUSLY <br /> E _ __.....—. . <br /> I I 7gwi�a <br /> Az <br /> TO -'TLS .�C ToATOL ANY EXTRA TANKS OA SEPF,F,ATF_. SHEET <br /> a�a as aaaa tl :gaa�laa�ar�a ��a ���o�a���laa <br /> P <br /> I� L (S E ATTACHMENT WITH CONDITIONS) <br /> NPLAN REVIEWERS NAME PHGtl�AIMEI 17tlI�'IVIIII�IPI" R;P'TI lrn�l IDATE =13I <br /> ` ��peuuq�µ� NugMy ywryn� n wpprying mW wu Xp my pgpl mx ynyl yMW,glWXxgn�Apn�pMpN� -i fA NINE W�Wnxnyn � <br /> ri IIIIIIWWII I'I a la ilal I�Illilllli IIII'q Ilpl IINAaI IIIIIIIWVIIXI 'WIAI� IgNIIMIapI MI11111uNIItlI IINWN�Ra11111MIP.NBIII1111�AlIIIWIAII IIVIAXAIa.INIIAtllnrluNllllll M I IIIIIINII�IIIUIIWltll11'IIInINaIIIIAII�INIY•IIIIRIIIIINWIRpNIIX <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES AND REGULATIONS <br /> OF TRE SAN JOAQUIN LOCAL HEALTH DISTRICT. OYMER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY AMY PERSON IN SUCH MANNER IS TO BECOME <br /> SUBJECT TO YORKMIN'S COMPENSATION LARS OF CILIFORNIA.1 CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY THAT IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT <br /> TO WORKMIN'S COMPENSATION LAWS OF CALIFORNIA. COMPLETE DRAWING 01 ATTACHED PLOT PLAN SHEET, <br /> CALL FOR ALL NECESSARY INSPECTIONS AT LEAST 18 HOURS IN ADVANCE <br /> _p <br /> SIGNED X % TITLE: R DATE: 913 OOpm <br /> 61 <br /> ACCEPTED BY TITLE: DATE: _ <br /> l�!a�9IiNF l l I <br /> I'�BIIWdI'Jc�EWRiJ�IUIIVII'N06VI4ARVEli Is9tlgIBRL'WBIRAHIIR011BXYIWIWJu"WutlduilG6lWiM�VRII�ItlNWL1GI11tl6911NutltlIIVOSIAN' rlWl&OtlNll'ItlpItlNNA�iIWOIIA'W69NWGI.k�wMJ01&70pdIdBIUYYkI�RtlltldltlO�tlBd011WYUIF�fJN"ditllNO <br /> IMAIINaumNAl01MA1ulunlllnmNNaWNIxmIInNeAInIInmA%IiWnIYXpnWIIlA1IgIInI:InI1IluInMOMIUNXpMAlnul%uuPnXlu°uAllWreIIIINIIInWIIIr11UI111NIlolAlltlin rlmlllWdxlx!IigNNNIMIff NI i IlnrrnRllirl•1nr@nnnbmAyoAMII1IIII1NInnplllul llrnlllnn:AlNl'InINu'.NMwIriIIMIf11Ih1PIIIINrM <br />