Laserfiche WebLink
l:eil:_ki:ki:ti:t 2txti2k2t2tYt2tit�ti:litititilitYtFtLti'Nlit:• ti ,G,6�D 3 <br /> F APPLICATIOI!--OR PERMIT !; SAN JOAQUIN LOCAL HEALTH DISI>lT G �. <br /> r UNDERGROUND TANK !; 1601 E HAZELTON AVE., STOCKTON CA k: <br /> g CLOSURE OR ABANDONMENT t: Telephone (209) 466-3420 <br /> :::'::'::':::N:t�:t:'X):t):W):N:t%��):N:t%1Y.1Y:tY.t):qiX?:11N:t):t>:tY.X):�Y.�Y.�Y.�Y. <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYSFRO E APPROVAL DATE. 00 NOT WRITE 1N ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> REMOVAL TEMPORARY CLOSURE' ABANDONMENT IN PLACE <br /> EPA SITE 1 CAC 000170541 PROJECT CONTACT k TELEPHONE 1 Paul Curry 464-7374 <br /> F FACILITY NAME CURRY'S WAREHOUSE SALES PHONE s (209) 464-7374 <br /> A <br /> C ADDRESS �i7-E. Fremont Street Stockton, Ca. <br /> I <br /> L CROSS STREET Golden Gate Ave. <br /> 1 <br /> T OWNER/OPERATOR PHONE 1 <br /> Y Paul Curry (209) 464-7374 <br /> C CONTRACTOR NAME Stockton Contracting Group, Inc. PHONE 1 (209) 462-5082 <br /> 0 <br /> N CONTRACTOR ADDRESS 1000 N. Union Street CA LIC 1 528156 CLASS A <br /> T . <br /> R INSURER On File WORK.COMP.1 ON FILE <br /> A <br /> TFIRE DISTRICT Stockton PERMIT 111NSPTR app"i� /,"p <br /> 0 LABORATORY NAME Canonie PHONE 1 / <br /> R <br /> SAMPLING FIRM* Canonie SAMPLING METHOD By Hand / brass cylinder <br /> TANK ID 1 TANK SIZE CHEMICALS STORED CURRENTL CHEMICALS STORED PREVIOUSL <br /> T A <br /> A 39- c1 Q y- ��r 4000 Un-Leaded Gas q <br /> N 39- <br /> - --------- --- c <br /> K 39111, <br /> - <br /> --------------------------- <br /> 39 <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPAP.A � i1/j k <br /> I� <br /> P ___ APPROVED APPROVED WITH CONDITIONS DISAPPROVED /CFS IA& " <br /> - --- <br /> L (SEE ATTACHMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME Q�_ q <br /> N v ` <br /> -------- -_ .) G_ <br /> ------------------ DATE ---------y=-- - ------- <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO SECOM <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING S16NATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FO INSPECTIONS AT LEAST 48 HOURS IN ADVAN <br /> --- ----------- - - ------------------------------------------------DATE - --------- <br /> CF USF 0 Y-- 11 Ol6 !1/A8 <br /> syyssssssssssssssss sssssssssssssssssss sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssstss <br /> IdDOy{ I�6Rd'j3/I LOO/E I D��0111 1U%BUE I AMOUNT RCVD I CKt/CASH I RCVD BY I DATE RCVD I PERMIT 1 <br />