Laserfiche WebLink
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 /> EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WHITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> X REMOVAL _ TEMPORARY CLOSURE CLOSURE IN PLACE <br /> EPA SITE #CAL 000057083 PROJECT CONTACT 6 TELEPHONE S Jim Thorpe 0i] , Inc. (209) 368-6175 <br /> F FACILITY NAME Panella Trucking, Inc. PHONE # (209)943-5000 <br /> A <br /> C ADDRESS5000 E. Fremont St. , Stockton, CA 95215 <br /> 1 <br /> L CROSS STREET "� �, G.iF K D :.��,G 5 t- <br /> 1 <br /> T OWNER/OPERATOR Panella Trucking, Inc. PHONE # <br /> (209)943-5000 <br /> C CONTRACTOR NAME Jim Thorpe Oil , •Inc. PHONE # (209) 368-6175 <br /> 0 <br /> N CONTRACTOR <br /> 1 ADDRESS P. 0. Box 357, Lodi , CA 95241 a LIC # 495699 CLASS A, B, Haz, <br /> R INSURER Firemans Fund/GenstarWORK.COMP.N 00719747 <br /> A <br /> C FIRE DISTRICT The City of Stockton PERMIT <br /> T upon approval <br /> 0 LABORATORY NAMEGeoAnal,ytical Labs COUNTY San Joaquin PHONE # (209) 572-0900 <br /> R <br /> SAMPLING FIRM 1 tical Laboratories PNaxE B (209) 572-0900 <br /> nnn 111,1nn1�p7 II1�11 <br /> Y NK ID TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> 79 12,000 gallons diesel fuel 1479 <br /> T 39- r r — n n „ „ „ <br /> A 39- ,: O „ <br /> H 39• n n <br /> K 39- <br /> I- <br /> " gasol ne — —r-- <br /> 39- - a nnn " <br /> 39• - —�'�—" STT e <br /> P II11 �TTTiiTITffITiTITT1T <br /> L _ APPROVED X APPROVED WITH CONDITION(S) DISAPPROVED <br /> A <br /> N (SEE COP^.TIC.YS'PELOW AND/OR ON ATTACHMENT) <br /> PLAN REVIEWER'S NAME Ce � OAT! 7— <br /> nnnuinnnnnunnnnnnnnnunnnunnnm mnnnuununnuunnnunnunnnuuunununnnl <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 9 CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.• CONTRACTOR'S MIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> "1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS Of CALIFORNIA." <br /> APPLICANT'S SIGNATUREI LE Contractor/Agent DAT! -3 ' <br /> CONDITIION(S)t /J I <br /> km",, 14-1 a d-v 4c4te-4L-- ?lLj <br /> I-K s',,tzC- <br /> �r on <br /> !N 23 046 (RBVIBBd 9/11/96) PBBB 3 <br />