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ENVIRONMENTAL HEALTH DIVISION APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT APPLICATION FOR PERKAMENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOF WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: X REMOVAL TEMPORARY CLOSURE _ CLOSURE IN PLACE lti e.ad's d % �. S -laze C'46f c✓i L t c dY. j s c �f-//c7UiC i a f Fcr.r o- ST.tz j d� 1 o/j BZ /J�6<itil�/�%v�C / ,,L 3/ifj`f ER 23 046 (Revised 1/10/92) Pove 3 EPA SITE / CAD 089881759 PROJECT CONTACT L TELEPHONE B Don Neri (202)465-2636 F FACILITY NAME Aurora Body Works, Inc. PHONE ' (209)465-2636 A C ADDRESS 446 N. Aurora St. Stockton, CA 9520x. 1 L CROSS STREET Fremont St. I 1 OWNER/OPERATOR Donald Neri PHONE / (209)465-2636 Y C CONTRACTOR NAME ,)1111 'I'llorpe oil, I11C. PHONE R (209)462-4581 0 N CONTRACTOR ADDRESS351 N Beckman Rd. P.O.Bx. 357 G LIG B 4 56 CLASS B R INSURER Piresulans Fund/ Pacific Insur. Co., LTD WORK.CCMP.1 d E! HIT ITS. u APERMIT C FIRE DlsrRlcr Cit of Stockton R 0n approval T 0 -- LABORATORY NAMEGeoAnal tical Laboratories PHONE B - R PHONE B SAMPIING FIRM Same as above 11I111II1IIIIIIIIIIIIIIII TANK IDN TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DALE UST INSTALLED TANK 39- 550 gallon gaanl ins TT- I 39- A 39- N 39- K 9- 39- 39- 39-iiirrrrnrlrrnnrrrrrmrnr 39 - III I fill I IIIIHIIIIIIIllfilmnnnnrrrnrrrmrmnlnr mmrmrrrmrrrrrrrrrrrrrnmmrr mrrmmrmmrrr L APPROVEDAPPROVED WITH CONDITION(S) DISAPPROVED WITH CONDITIONS) A c (SE ATTACHMENT N PLAN REVIEWERS NAME ��,(,� DATE 111111111111111111111r TlrrirlIIl nllrrrrilrlTlllirlrrlTlTrrrirrirTllTlrTTi11IIIII'MI nrrrrTrrrrrIIIIT it APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OMER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I 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 TO BECOME SUBJECT TO WORKER'S CCMPENSATIOR LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS Of CALIFORNIA APPLICANT'S SIGNATURE: a TITLE Contractor DATE 2/15/94 lti e.ad's d % �. S -laze C'46f c✓i L t c dY. j s c �f-//c7UiC i a f Fcr.r o- ST.tz j d� 1 o/j BZ /J�6<itil�/�%v�C / ,,L 3/ifj`f ER 23 046 (Revised 1/10/92) Pove 3