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rts' tIt Ct It CII. t-ttt tt W;It It It tato R:Rtat1:9at1 late4 tatatal IV <br /> t, <br /> APPLICATION 'PERMIT t SAN JOAQUIN LOCAL HEALTH DIST <br /> a UNOER6ROUN0 TANK t; 1601 E HAIELTON AVE., STOCKTON CA t. <br /> t CLOSURE OR ABANDONMENT t: Telephone (209) 468-3420 t: <br /> .tw Is:wn::v:�(;:s:X>:txna;:n:n:�x n�n:n:n:1a�>:1>:n:n:0;:n;;r.n:*r: <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBRICAXAV n <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE 4,1 U <br /> _x_ REMOVAL ----- TEMPORARY CLOSURE ____ ABANDONMENT IN PLACE AUG 1 6 1989 <br /> EPA SITE 1 CAC 000195873 PROJECT CONTACT i-TTELEPHONE 1 or ) 7�eC HEA TH <br /> F FACILITY NAME Henry Wolters & Son PHONE 1 <br /> A - _ ------ ----- .--. -- <br /> C ADDRESS 331 N. Aurora, Stockton, CA <br /> L CROSS STREET Lindsay <br /> I --- <br /> T OWNER/OPERATOR Charlie Skobrak PHONE 1 (209) 465-2667 <br /> Y <br /> C CONTRACTOR NAME Jim Thorpe Oil , Inc. PHONE 1^-(209•) 462-4581 <br /> O -- -- —- <br /> N CONTRACTOR ADDRESS 351 N. Beckman Road, Lodi , CA CA LIC 1 495699 CLASS A, Haz. <br /> T <br /> R INSURER on file WORK.COMP.1 on file <br /> A - �1 - -. _-�- - --�_�_�--- <br /> C FIRE DISTRICT City of Stockton -� IPERMIT t/INSPTR - <br /> T �L — <br /> 0 LABORATORY NAME Canonie Environmental PHONE 1 (209) 983-1340 <br /> R <br /> SAMPLING FIRM$ sante SAMPLING METHOD brass tube-see #5 on removal plan <br /> TANK ID { F5,000 <br /> CHEMICALS STORED CURRENTLYCHEMICALS STORED PREVIOUSL <br /> T <br /> A 39-__x!! !F--�� solvent <br /> - - -- - <br /> re ular asoline <br /> K 39 <br /> --------- <br /> 9---------------------------- <br /> 39- <br /> ----------------------- <br /> ST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> F APPROVED APPROVED WITH CONDITIONS DISAPPROVED <br /> LSEE ATTACHMENT WITH CONDITIONS) g <br /> A PLAN REVIEWERS NAME DATE r - <br /> N _ ? !Tti_ <br /> .....j <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING,; •I CERTIFY THAT <br /> IN THE PERFORMANCE Or THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: `t CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> __---- S ��� __-_--__Vice------- -----------------------------President TE_- _8/14/89- <br /> OFFICE Of ONIT-41 13 116 itltl 077 <br /> ----------- <br /> ff{f{fliffffffifffffffffffffitfffNfffftffffffffff{ffifffi{{f{fifftffffff{fffftff{ffffif{f{ffftfffffffffiffff{fft{{f{ffff <br /> SWEEPS t COMP t LOC CODE 01ST CODE AMOUNT DUE AMOUNT RCVD CKI/CASH i R� BY 1 DATE RCVD = I PERMIT 1 <br /> JN/s y� _ C <br />