Laserfiche WebLink
APPLICATION FOR <br /> PERNWT SAN JOAQUIN AALDISTRICT <br /> UNDERGROUND TANK 1601EHHAZELTONAVE. STOCKTONCA <br /> II CLOSURE OR ABANDONMENT Telephone ( 209 ) 468-3428 <br /> APPLICATION FOR PEINANBIT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMjT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT TRITE IN III SHADED AREIS. INDICATE PERMIT TIPS BBLOV: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> r F PROJECT CONTACT 44 <br /> I ,f I PHONE # _i Q�/ SZK 965." <br /> A D.�i_ - J— <br /> C FACILITY NAME ADDRESS � �z <br /> L OWNER ADDRESS <br /> T CROSS STREET PHONE-# 2GS/ �P- 1(n /C 1 <br /> C CONTRACTOR NAMEy— L PHONE IN .?ay / 5Z 41 9653 <br /> O <br /> N CONTRACTOR ADDRESS CA LIC # <br /> T _�Gd <br /> R LIC CLASS / WORK . COMP . # INSURER <br /> C FIRE DISTRICT T PERMIT # <br /> T —.—--- _.._.. — ...---L--- . _.--- -- - <br /> 0 LABORATORY NAME PHONE # 201/ 527 - 4050 <br /> R ----- ------0-A) . -L-LU LABS -- -- <br /> SAMPLERS NAME SAMPLING METHOD <br /> NNNipdIIlNI <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID N I CURRENTLY PREVIOUSLY <br /> E —.... - ---- _ —_--... ---...___ — <br /> M I RPQUIQY TO <br /> I ITO <br /> C To <br /> — <br /> A TO <br /> L II��N�H�� LIS ANY EXTRA TANKS ON A SEPERATE SH ET <br /> --° l!!Eli, NIIN�I� „ �IIIIIiIIIN�iINIINNIII''Il I <br /> P <br /> L (SEE AT CHP!ENT WIT# CONDITIONS) <br /> A PLAN REVIEWERS NAME DATE S'-Z 86 <br /> N <br /> =_=-1 NNN�NN�19 !�Nafy !INIIINNNN�IINN �INNGPJ!iiNN <br /> APPLICANT MUST PERFORM ILL FORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ST/TE LAWS, IND RULES AND REGULATIONS <br /> OF THE SIN JOAQUIN LOCIL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNITURE CERTIFIES THR FOLLOWING: "I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER IS TO BECOME <br /> SUBJECT TO WORKMIN'S COMPENSATION LAWS OF CILIFORNIL" CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED, I SHILL EMPLOY PERSONS SUBJECT <br /> TO BORIMIN'S COMPENSATION LAWS OF CALIFORNIA. COMPLETE ORATING ON ATTICBED PLOT PLAN SHEET. <br /> CALL FO ALL NEC�SSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE d <br /> SIGNED X � u�^ � TITLE: • S DATE: �Z�a <br /> ACCEPTED B TITLE : DATE: <br /> N "I i, �INNNN'� I ''i" ' 'I�NiI NIIN�iINN!I � 'I ' IiNNNNI�NINIiN� AIN "iNIi�N INI�NIN�I' R <br /> I 'IIIIIII�sNDIIDIIluDD1@IDuuu1111NIIIUVIDBDSINIw1UID1111RIumuBW�1INIm1119I�HNIINVDDIIIIIDIIDIDIDtlV911IIWNIDIDIIIDBIINODDIIt I DIIIDNMIIDDIMDNDIIMiVDDH�DNB�DD�D IDBIDDli�7 �Ial <br /> 11111111"i IIIIIIIIIIIIIJLIIIIIIIIIIII 1111iIIIIIIIfill 1111111111111pIIIPIIIIIII1IIAllfilll111111111111111111111111111111!1A 1111IIIIIIIIIIIIIIi�Nn11NIIIHIItlIIIIII!IIIIIIIIIIIIIIIIJIiICllllllllllllllln�pl III II I;I'llllllllliLIIIIIIIIIFIIIIIIVII!III!II IIIII II I iFiIIIIII1PIhIRiI "I I SII Illllllllil i II111191101111p111mN��IWAOdfllll.9f@III�AtlI�11gINIAILu <br />