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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br /> WINES 90 DAYS FROM THE APPROVAL DATE. DO NOT VISITE IN ANY IMAGED AREAS. INDICATE ►ERMIF TYPE SEOUL <br /> )( REMOVAL _ TEMPORARY CLOSURE —_ CLOSURE IN PLACE <br /> EPA SITE P CAD 004771606 PRaecr c0Nr6cT 1 TELEPRONE P Jim Thorpe 011 , Inc. (209) 368-6176 <br /> A FACILITY NAME Cal Tank Lines , Inc. PH011! / <br /> (209)466-3554 <br /> C AnDRESS 3105 S. E1 Dorado St . , Stockton , CA 95206 <br /> I <br /> L CROSS STREET I Vy St . <br /> T OMER/OPERATOR PHONE / <br /> T Cal Tank Lines , Inc. (209)466-3554 <br /> OC CONTRACTOR NAME Jim Thorpe 011 , .Inc. PHONE e <br /> (209) 368-6175 <br /> N CONTRACTOR ADDRESS p. 0. Box 357, Lodi , CA 95241 CA uc R 495899 CLASS A, B, Haz. <br /> A INSURER /Genstar/ Kemper W RK.CONP.0 007197-97 <br /> C FIRE DISTRICT The Cit of Stockton PERMIT 1 <br /> I u on a roval <br /> 0 LABORATORY NAME. GEOAnalytical <br /> IN COUNTY San Joaquin PHONE B (P09) 572-0900 <br /> SAMPLING FIRM GeoA7;J;1 tical PHONE S (209) 572-tA.900 <br /> — nnnnu��G�l��l�r.,nnm <br /> TANK 312E CHEMICALS STORED CURRENTLY/PREVICUSLY DATE UST INSTALLED <br /> 79- a`all�col <br /> nc g] flea] „k <br /> T )9• <br /> A 39- uk <br /> M 79 <br /> K 79- <br /> 39. <br /> 79- <br /> nnrrnnnnlrmm�rmm mmnmrmmmmmm�r Ilmrmrmtrrlirrrnmrtitrtrtltrrr rtnmmlrmmnr <br /> I APPROVED APPROVED WITH CONDITIONS) DISAPPROVED <br /> A (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> M <br /> PLAN REVIEWER'S NAME - DATI :"� `�' •� <br /> — IIIIIIIIIIIIIIIIIIIIIIIIII11111111111111111111111 1 111111111111111111111111111111111111111111111111111111111111111111111111 <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNIT PUBLIC NEALTR SERVICES. OUNER ON LICFNSED AGENT'S SIGNATURE CENTIf1U INN FOLLOWINGS •1 CERTIFY THAT IN <br /> SIR PERFORMANCE OF THE UORK FOR WNICN TRIS PERMIT IS ISSUED, 1 SMALL NOT EMPLOY ANY PERSON 19 SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S MINING OR SUBCONTRACTING SIGHATURE CERT1P111 THE FOLLGIINGI <br /> "I CERTIFY THAT IN TME PERFORMANCE OF THE WORK FOR WHICH I IS PERMIT IS ISSUED, I SMALL EMPLOY PERSONS MJICT FO LbRKER'E <br /> COMPENSATION LAYS OF CALIFORNIA." <br /> I <br /> APPLICANT'S EIONATUREI LE Contractor/Agent DATE 8/17/9 <br /> CONDII10P1(S)N <br /> cc,,JW 7I3 <br /> IN 23 046 (REvIEEd 9/11/961 ►ESE I , <br /> i <br />