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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PER,%t1T FOR PERMANEN-'EMPOFAR�CLOSURE CR APANCONMENT IN PLACE OF UNDERGROUND 4AZ3FCCUS SVESTANCES <br /> STORAGE TANW'SI EXPIRES 30 LAYS FROM THE APPROVAL DATE. CC NOT+NRf,E IN ANY 3HACE0 AREAS. INDICAT,-Pc MIT TYME <br /> I: REMOVAL ❑ 7EMPORARY CLOSURE M CLOSURE IN PLACE <br /> FACILITY IN=ORMATION <br /> EPA SRE DOIDD P OJECT CONTACT E ?HONEpoog 479-1 Al a <br /> FACLI-YNAME North Stockton Auto Service PtiONE. <br /> I ADDRESS 8709 N. Davis Rd. , StQcktnn - CA 9520P <br /> CRCS�sTRE— Thornton Rd. - <br /> OYJN94CPEP.ATOR Ed Niemann ?HONE" <br /> CONTRACTOR INFORMATION <br /> CONTaACTORNAME Jim Thorne i PHONE# <br /> CCNTRAC'OR,4CC.RESS P.O. Box 357 , CALICO CLASS <br /> !-SURER Gen Star/Golden Eazle •AloRKERDOMPMn4ri Unit 71 C) <br /> FIREDIS-R:CT City of Stockton PERM-ITz <br /> LAECRATORY'NAME GeoAnal tl 1 L COUNT" OMCNP0 <br /> SA::P':iNG FIRM --CNE s <br /> I SAme AR Ahoy <br /> TANK INFORMATION <br /> -ANK!0 S I TANK SIZE I TANK CCNTE`iTS(PRESENT 3 PAS- I DATE INSTALLED <br /> 39- 550 gallons Waste Oil 1978 <br /> 39- <br /> 39- <br /> 39- <br /> 30. <br /> aPPLI= -LST P4RFCRid PLL NAORK;N ACCOROANOE�YITH SAN JCAQUIN COUNTY CROiNANCES,STATE 117PJ; F!O ZIAL lAW9.AN iI.LEa ANO <br /> Rt i'J.AT'Ctl5 <br /> OF ?AN JCAQUIN =-4^ PUBLIC KEN.74 SE�VICS& ONMEP. CR UCENSEO AGENTS SIGNATURE CERTIFI!S -HE F•CL-OWINC: •I <br /> CEPTIFY THAT IN TNI PE°KI!A"CE OF-HE WORK FOR�WICH THIS PIRMtT S:SSU0 I SHALL NOT IV-PLOY ANY P!RSC4 IN SUCH A MANNER AS <br /> TO 3_CCY2 iU84ECT TO'v40RK S'S C --fNSATION LAWS 00 CAUFORNL1- CONTRA=ftl HIRING CP 9UBCONTRA0TING SICNATUF.E CLOW IFIES <br /> 'HE PCLLCJdNO: 'I CER--,#Y THAT 1 E P OR _ OF' I SHA.L EMPLC"PSPSON3 SL'&E T TO <br /> ,.'.CFw5P'S CCMP5NSATICF LAW' FCA' RN' <br /> Contractor DAr- <br /> AoPL,CANTS SIGNATURE <br /> APPROVED APPROVED WITH CON017ION(S) 7-1DISAFFROVED i <br /> (SEE CONOITICNS 81-OW ANGOR ON A.7TAC4M113NT) <br /> �II <br /> N PLAN RE`i1E'NER'$NAME 12 JyA GATE 17 n <br /> ANY CEVWTONS FROM THIS AP°LICATICN MUST:E 3 ' ,R1rTED TC EHC FORAPPRCJAL PRIOR TO COMMENCINC WORK. <br /> CONuI IONS: � <br /> JL <br /> y Z <br /> W :2 <br /> _;{a'3sE(RE'/ISEO Od119145; Piga 3 <br />