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ENVIRONMENTAL HEALTH DIVISLOI <br /> APPLICATION 1011 UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> APPLICATION FOR PERMANFFIVIUMPORARI CLOSURE ON ANANDOIMENI IN PLACE Of UNDfRGROUND NAIAROOTS SUBSTANCE STORAGE TANK <br /> IRIS PERMIT EXPIRES 90 DAYS FROM INE APPROVAL DATE. DO NOI WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOII <br /> X REMOVAL _ TEMPORARY CLOSURE _ CLOSURE IN PLACE <br /> rEPA SIZE I CAC 001022416 I PROJECT CONIACI B IELEPNNE / > <br /> _ 009)466-0131 Paul Souva <br /> F FACILITY NAME Valley Wholesale Drug C. , Inc. I PHONE I (209)466-0131 <br /> A — <br /> C ADDRESS 1401 W. Fremont St. Stockton, CA 95203 <br /> ' I <br /> t CROSS STREET Pershing Ave. _ <br /> 1 "ER/OPERATOR PHONE / <br /> V Valley Wholesale Drug Co. , Inc. (209)4/66- 0/-r <br /> C CONTRACTOR NAME JI111 Thorpe; Oil , 11Rc, PHONE 1 (20y)4G2-4501 <br /> O _ <br /> N <br /> CONTRACTOR ADDRESS 351 11 0ecluuan Itd. 1•.0.1)x. 35'.1 f a Llc I 1,( 4 Lt <br /> cuss A U -11az. <br /> R INSURER FLresgenls Fund/ Pacific Insur. Co. , LTU VORK.COSP./ ate`Cbmp. Inss-"Fuiel <br /> A <br /> C TIRE DISTRICT The City of Stockton PERMIT 1 <br /> 1 --- 011 auurov11l of plan <br /> 0 LABORAIOIY NAME <br /> R ---- QuA Iyt -sal Laboratoaies 1j PRDNE 1(209)572-0900 <br /> SAI'CI 1"r 11 P14 CeoAnalytical Labatories PHONE 1 (209)572-0900 <br /> - IIIII111111 IIIII1�11111111111 <br /> Irylk Slrs CHIN I[ALS SIOIIE0 CM N11. I VIOUSLY DATE USI INSTALLED <br /> 39- 1L <br /> a on Macsoune � <br /> A S9- <br /> N 79 — <br /> K S9- <br /> S9- <br /> - liiinnnnnnnnnnnnn nnnnnunnua�nnnnnl nnnnnnnnnnnnnnnnnnm nnnnnnnnnm <br /> L APPROVEDI if <br /> TIN CONDITION($) DISAPPROVED <br /> A ��//. ' kit if C I NIIN CONDITIONS) <br /> N DATE <br /> IIIIIIIIIIIIIII11111111,111111f1�Id1fiIIIi//;IIIf111111III <br /> 1111111tttttt111tttt11111tttllltlllllllllttlfl1Tl11ttFlllllltltltlttll <br /> APPLICANT MIST PERFORM ALL WORK IN ACCORDANCE NIIN SAN JOAQUIN COUNTY ORDINANCES, STATE LAOS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OMER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWINO1 ^1 CERTIFY THAI IN <br /> THE PERFORMANCE Of THE WORK FON VNICN THIS PERMIT 11 ISSUED, I SHALL NOW EMPLOY ANY PERSON IN SUCH A MARREN AS 10 BECOME <br /> SUBJECT IO WORKER'S COMPENSATION LAWS 01 CALIFORNIA.- CONIRACIOR'S HIRING OR SUSCONTRACTtNO SIGNATURE CERTIFIES THE FOttO INOi <br /> "I CERTIFY THAI IN INE PERFORMANCE OF INE SANK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT 10 WORKER'S <br /> COMPENSATION LAWS OF CALIFONI <br /> APPY ICANT'S SIGMA IUREI DATE7�1 hr <br /> Dj <br /> G'OnQI fial.s �- r� <br /> °N 21 046 (RevIsed 7/10/92) Page 3 <br />