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rt}tfi:tit%w(.rt}:k}:k}:tiktn:ki:tkk}:trla{t}:ki.t}:t}.ti:LI:tvtvt}: hfi'l2ti.t}. <br /> w APPLICATION FOR PERMIT k: SAM JOIQUIN LOCAL HEALTI�ISTRICTk: <br /> t: UNDERGROUND ?ANI t: 1601 B HAIRLTON AVR., STOCK?ON CAk: <br /> t: CLOSURE OR 11INDONNENT t: Telephone (2091 168-3120 t: <br /> APPLICATION FOR PRRMANEKT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HIIIIDOUS SUBSTINCES STORAGE FACILITY <br /> THIS PERMIT RKPIRHS 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN 111 SIIADID AREAS. INDICATE PERMIT TYPE 19LON: <br /> REMOVAL TEMPORARY CLOSURE —_ ABANDONMENT IN PLICI <br /> EPA SITE I —CAC 000203758 9 0�g) PROJECT CONTICT A TELEPHONE I <br /> _ <br /> P FACILITY NAME The Service Station (PHONE 1 209-836-5203 <br /> I <br /> C ADDRESS <br /> 1 1100 West Eleventh Street, Tracy, California 95376 -_ <br /> L CROSS STREET Ninth Street <br /> T OYNBR/OPBAdTOR PHONE I <br /> Y Clyde Walther 209-836-5203 <br /> C COYTRICTOR NINE Telic Engineering Corporation - PHONE 1 209-465-2000 -- --- <br /> 0 287 N. Cardinal <br /> I CONTRICTOR IDDRBSS P 0. Box 2076, Stockton, Ca, CI LIC I -- CLlS3 <br /> R INSURER 95201 WORK,COMP.1 <br /> C PIRG OI STRICT <br /> T -- PERMIT I/IBSPTR <br /> T racv _-- _— <br /> 0 LABORATORY NAME PHONE I <br /> SAMPLING FIRM' SAMPLING METHOD <br /> T <br /> -- NIIKBYNNUIIINIRIIIIIINKNNNIIIIIIItlXNVINIIItlIIUIINCN!IIN1ININIiVUUBI --- _ <br /> TANK ID I TANK SISE CHEMICALS STORED CL'RRENT6 CHEMICILS STORED PRIVIOUSL <br /> A 39 ------ ---- 1000 coal. x waste oil <br /> LIST IDDITIONAL TANK IHFORHATION AS NEEDED OY SEPARATE FORK <br /> UIIIIIINW.VIIIIIIIUIJVUVIIIIIIiIVNINiIIIINIUNVIUUIIIIUNIUIIIIIIUIVUIIWIIIVI;AIV. UIINI!IN111VUUIfiIIVNIflIIIIIIIUNII;IUMIU!nVVIIIIL4V'!YUfdIIINIIIINIDI{UUUINVpUI!IIIfl19UiIDIIIINIVYUYCIUNL'NN9UR'Hi�GIIIIIUUIlYIJ19UIUuMNUL'BIUUIDIIIBIII@IUIdp;IINUVIVIIIL�IICIV6NIIIIINIVUIIIIIINYYIUNL" � <br /> P -__ APPROVED --APPROVED WITH COHDITIOHS DISAPPROVED <br /> L (SEE ATTACIINENT WITH C04DITIONS) <br /> A PLAN REVIEVERS NINE <br /> --------------------------------- <br /> N __DA16 <br /> UUVWVYIIIUUYNP�IIIWIYUIUYIVUIWNNRUNWUIVWIWtlVVIVVWUUNUYIVYVUUUWIVIWUR4WIVYVIWVVIYUIVIINSIVR1VN7111VNUIWVWINIVNEINVYNVNLNVItlNVWDIIUUUWUNpVNItlVVNWVWNWVVIHWVVNUUWIWVYNOUYIYRIYIYIVWCYVYNVYNV6INN <br /> IPPLICANT MUST PERFORM ALL YORK 11 ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES IND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. GREER OR LICENSED AGENT'S SIGNITURB CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE Of THE YORK FOR YNICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCK MINNER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAYS OF CILIFORNIA.' COMTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY ?III? IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT 13 ISSUED, 1 SHALL EMPLOY PERSONS SUBJEC <br /> TO YORKER'S CONPENSITION LAYS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVAN6-F:Z�,�� (� <br /> SIGNED <br /> ---------------- ---------------.__—_-._DATE---------- <br /> OFPICE USB ONLY•-EAI 21 016 12/J! <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSISSSS <br /> SYBEPS I--COMP I I LOC CODE I-DIST COONAMOUNT DUB I- AMOUNT RCVD CKI/CASA-I—RCYO BY I DATE RCVD PERNfT <br />