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ENVIRONMENIAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE WANK CLOSURE PERMIT <br /> APPI ICATION FOR PEIMANENI/TEMPORARY CLOSURE OR ABANDRNMENI IN PLACE Or UNOEIGROUMD HAZARDOUS SUBSTANCE STORAGE TANK <br /> IRIS PERMIT EXPIRES 90 DAYS FROM IRE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICAIE PERMIT TYPE BELOWI <br /> X REMOVAL _- TEMPORAAY CIOSURE CLOSURE IN PLACE <br /> EPA SIIE P CAC 001022416 POJECT CORIACI A IELFPNONE B <br /> IR (209)466-0131 Paul Souva <br /> FACILITY NAME Valley Wholesale Drug CD. , Inc. <br /> A PRIME I (209)466-0131 <br /> , <br /> 1ADDAEss <br /> 1 1401 W. Fremont St. Stockton, CA 95203 <br /> 1 -- <br /> I. CROSS STREET Pershing Ave. . <br /> iI OWNER/OPERATOR PHONE / <br /> Valley Wholesale Drug Co. , Inc. (20 e/`6- o/,S <br /> C CONTRACTOR NAME J1111 'Thorpe OUT 111C. PHONE P 1209M62-4581 <br /> io <br /> j ; CONTRACTOR ADOREss351 N UeckHlan Ittl. P.O.N. J5 a LIC P 1195G/ 9 cuss eapp. AaL <br /> R INSURER Firesmatis Fund/ Pacific Insur. Co. , LTU WRK.CO1w.R NO LWIT. Inn -FUid <br /> A <br /> C FIRE DISTRICT The City of Stockton PERMIT / <br /> W - Olt auurovill of plan <br /> 0 IABORAICOY NAME PHONE X(209)572-0900 <br /> R QoAnalytic81 I ;iboratayiev <br /> sAMP1IIla IIPH GeoAnalytical L.abatories PEONS OF(209)572-0900 <br /> — IIIIIIIIIII (IIIII�IIIIIIIIIII <br /> K,.ID O r IAHA: Sirs CHEMICALS STORED CMA ILY/PREVIOUSLY DATE USI MS TA LEO <br /> ine <br /> !9- L A <br /> 1 39- - a n O <br /> A 19- <br /> M 39- <br /> K 19. <br /> 19- V / <br /> !9- <br /> � 111111111111111111111111 1111;APPA <br /> I ILII IIl OVED WITH CONDITIONMS) DISAPPROVED <br /> A CHNENY WIIN CONDITIONS)" tlllllllllllll (li nl11 I �Innlunmimm�nmm�mnmliiiiunmTlllll lil/1I/t1iIlI11I111 <br /> APPLICANT NNI PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN CONIY ORDINANCES, STATE TAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC NEALIN SERVICES. OWNER US LICENSED AGENI'S SIGNATURE CERTIFIES THE FOLLOWING, •1 CERTIFY THAI IN <br /> THE PERFORMANCE Of THE WORK FOR UNICN TRIS PERMIT IR ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCN A MANNER AS TO BECOME <br /> SUBJECT 10 WORXFR'S COMPENSATION TAUS OF CALIFORNIA.- CONTRACTOR'S MIRING ON SUBCONTRACTING SIGNATURE CERTIFIES ONE FOLLOWING: <br /> "I CERTIFY THAI IN INE PERFORMANCE Of INE WORK FOR WHICH IRIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUNJECI 10 U(NIKEN'S <br /> CCIIPENSAIION LAWS Or CALTFORNI �+ ..,L <br /> APPLICANTS SIGNATUREI �O - ��_ -= 1jSILE 01,)*i�,0.e V,Ly.n DATE .7 <br /> , <br /> 1112 <br /> CondrluY15 r <br /> IN 23 046 (RevlTed 7/10/912) PRBB 1 <br />