Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONti,IENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PER'11:T FOR PERMANEN'REMFOFAR`CLOSURE OR ABANDONMENT IN PLACE OF UNCERGRCUND HAV=CUS SUBSTANCES <br /> STORAGE TA=.31 '!LPIRES 90 CAPS FROM THE APPROVAL CATE. CC NOT WRITE IN ANY SHAM AREAS. INDICATE?VMi7 TYOE <br /> X: REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br /> FACILITY INFORMATION gill 31TE DOIDD P OJECTCONTACT Ed ?HO - <br /> FAC.LITlNAME orth Stockton Auto Service <br /> I ACCRESS 8709 N. Davis jjq. StQC"on CA 9520-Q <br /> cRcsSs-,RE: Thornton Rd. <br /> owNER,PERpTOQ Ed Niemann ' ?H°NEy <br /> CONTRACTOR IIF M T N <br /> CCNTRACTOR NAME Jim Thorpe ' PHONE - <br /> CONTRAC-OR ACMESS P -0- B 57 CA LICA CLASS u <br /> INSURER GenStar/Golden E 1 RC—N <br /> FIRE DIS'R:CT it of Stockton PE. +ITs <br /> LAECRATORYNAME GeoAnal ti 1 L "' UNT' DHCNE= - <br /> iNG FIRM Samp as Ahou HONE d <br /> TANk Iff ORMATICN <br /> 'AVN IC 'AMCSIZE TAN C N?ENTS(PPZSENT 4 PAST DATE INSTALLED <br /> 39- 550 gallons Waste Oil 1978 <br /> 39- I <br /> 3y_ <br /> 139- i <br /> 139- d <br /> C 39- <br /> APFLf^`ANT MUST PERFORM ALL wCP,K:N CORC:ANCE.YITH SAN JOACUIN LINTY CROINANCES,STA'E LpJ'r P!C@\AL LAMS..ANO QLLEa".ANO <br /> REaU-1,1013 OF SAN JCAOUIN C01'j.PUBLIC K OR LtNICH SipMChIS PiRMIERS:3SUIM I SHALL NOT!.V.PLCOx LjCE%SE-- AGENTS Y;NY P!ZSCN IN SUCH A MANNER,AS <br /> CcariFY THAT IN THE PEPFORMANCE^ <br /> TC=S'AS SUBJECT TO WORKERS M0515A1104 Loc JS OF CAL'FCR-4, .` CONTR YCq PE 3SnT IS 9 UEO I$ A L EMPLC P PSGNe Sl' FIE? <br /> T'iE PCLLCIMNv: -1 CERTIPI'THAT I PELF RMANC_OFTHH'�+ORK R INHIOH T - <br /> 'aCFY@T'3 CCMFINSATICN LAWS O <br /> Contractor DArSy� <br /> ADCL,CAN^S SIGNATUR <br /> G APPROVED APPROVED WITH CGNDiTION(S) ❑ DISAPPROVED <br /> (SEE CONCIT.ICN3 B?.OW ANGOR ON P.TTALHM1IEN^ 1 <br /> li <br /> III GATE�'�g <br /> N PLAN RE'v7@NER'S NAME <br /> ANY CEYIAT'ONS FROM THIS AP'L1CA7ICN` usIr s SUBMITTED TC SHO FORAPPRC"/AL PRIOR TO CC <br /> MLIENC1Nu V 'I <br /> CON 'Tl Ns: r <br /> 14j� At <br /> P � T <br /> 19495; ya 3 <br />