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t;tyR tat;.tvt;;.tnl:1::1 tv t;tva Nvt;. t;. t;.NYl71:71kImtv.RMIV N.t;. <br />e APPLICITION FOR PERMIT a SAN JOAQUIN LOCAL HEALTH DISTRICTC <br />t UNDERGROUND TANK t: 1601 E RIZBLTON APB., STOCKTON CAt <br />t CLOSURE OR ABANDONMENT t: Telephone (209) 168-7120 t <br />t tt tt i t'tt tt tt 1:1 tt tt t t; tt R 1:1 ft t;-1:1 t; k;.t;1 1:0 1 t;: <br />IPPLICATION FOR PERMANENT/TEMPORIRT CLOSUII OR IBAIDONMENT IN PLACE 01 UNDERGROUND HAZARDOUS SUBSTANCES STOIICB FICILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL 0179. DO NOT 111178 IN 111 SHADED AREAS. INDICATE PERMIT TYPE IILOY: <br />v RIMOYAL _ TEMPORARY CLOSURE _ ABANDONMENT IN PLICA <br />(John Savidge 3926860 <br />BPI SITE I C/ •C OOOQ2 D5T_5�3__- <br />P <br />'TEL,EPHONE <br />PHONE <br />FACILITY NIKE Regal Station 11 E closed <br />1 <br />--- <br />C <br />IDDRESS 1448 N. El Dorado <br />L <br />CROSS STIBBT Harding Way <br />1 <br />OWNER/OPBRITOR Regal/Wickland Oil <br />PHONE 1 (916)921-1100 <br />1 <br />C <br />CONTRICTOR NIMI Town & Country Contractors Inc. <br />PHONE 1 (916) 392-1860 <br />0 <br />I <br />-- <br />CONTRACTOR IDDRRSS 117 Otto Circle, Sac. Ca.95822 <br />CI LIC 1238112 <br />CLISS A B-1 C-61 <br />I <br />IISURBR Kanakaris Insurance <br />VORK.COMP.1 RCS 19 04 85 <br />C <br />FIRE DISTRICTPERMIT <br />Stockton City Fire Dept. <br />I/INSPTI <br />T <br />�V <br />0 <br />LIBORITORY LIMBWestern a <br />PROVE 1 (916)662-4541 <br />R <br />---- — <br />SAMPLING FIRMt Western Geo -Engineers <br />SIMPLING ME1RODper S.J.L.H.D. <br />In <br />TIME 10 1 TIKK SII? CHEMICILS STORED CURRENTLY CHEMICILS STORED PRIVIOUSL <br />1 <br />1 J9- IQ 3 5000 gal _--_ gasoline reg. <br />J <br />5000 gal gasoline reg. <br />_ 5000 gal gasoline u.l. <br />5000 gal gasoline u.l. <br />-- <br />31• 5000 gal _— gasoline s.u.l. - <br />-- LIST IDDIT[OHIL TANK INFORMITION AS IFEDID 01 SEPARITI PORK <br />IUYWWYYYYYNNNRNIICWtlWYDN1BIWWRNNYJN. NgWYRDINIIHBNIUUYlNRNMKY!UIOSWN004Y1IIYI'�tlN�JWCBIWIYYYYtl"»IS'►tlL'�.MY�RY � <br />P_ _ IPPROVEO _ 1PPROPBD WITH CONDITIONS _ DISAPPROVID <br />L (SIR ACHMENT WITH CONDITIONS) <br />1 PLIN RBVIEVIRS NIMH _ D1TB OZ <br />N <br />IPPLIChIT MUST PERFORM ILL WORK IK 1CCORDINCE WITH SIN JOIUUIN COUNTY ORDINANCES, STATE LITS, AND RULES IND REGULITIONS <br />OF THE SIN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY TNI? <br />If TH8 PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCI MINVER IS TO BECOM <br />SUBJECT TO YORKER'S COMPENSITION LAWS OF CALIFORNIA.' COMTRICTOR'S HIRING OR SUBCONTRACTING SIGNITURI CERTIFIES TNR <br />FOLLOVIIG: 'I CERTIFY THAT IM THE PERFORMANCE OF TIIB YORE FOR WHICH THIS PERMIT 113 ISSUED, [ $HALL EMPLOY PERSONS SUBJEC <br />TO YORKER'S COMPENSITION LIES OF CALIFORNIA. <br />CALLFOR INSPE TTTPNS AT LEAST 40 HOURS IN ADVANCES <br />SIGNED _1 DATED -- <br />- 1r-------------- — -- <br />OFFICE OILF--EII 23 016 12/11 <br />SISS+L SI <br />SCODE' SIMOUNTSSRCVDSSSS SM$H SSSSRCYDSBYSS,SSS0119 <br />SYSEPSSISSSCOMP CSCODES DIST DUE AMOUNT K RCVDSSSSSSPERMIT <br />I <br />