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C to ft:R:R"R14 R:ftRI: :tvt'lul.ttn Gt:ti:ti:kt:t}:N.1.1:tt�a a Cy 'k'}.R:ti: /"'-""&Z <br /> r APPLICI , g FOR PERMIT t: SIN JOAQUIN LOCAL HEALTH .jtllCTk: <br /> E UNDERGROUND TANK t: 1601 ¢ HA18L10N AVB., STOCKTON CAt <br /> t: CLOSURE OR 111NDONNEUT t: Telephone (209) 168-1120 r <br /> k tt tt tt tt tY kt tt tt kt L't't k;'Nt a t}m t},ttk1 k t:ft R:tt'k'C1 kt� <br /> APPLICATION FOR PBRNANENT/TBMPORIRY CLOSURE OR IBAYDONMENT IN PLACE Of UNDERGROUND HIIIRDOUS SUBSTIWCES STORAGE FICILITY <br /> THIS PERMIT BKPIRIS 90 DAYS FROM THE APPROVAL DATE. DO NOT 111178 IW 111 SHADII AREAS. INDICATE PERMIT TYPE BELOW: <br /> X REMOVAL --- TEMPORARY CLOSURE ABANDONMENT IN PUCE <br /> — — — <br /> EPI SITE 1 C — <br /> JUU'1 `f`'IOff I q PROJBCT CONTACT I TELEPHONE 1 <br /> APp1.jEl) FOR f SIM HOBLITZELL/FALCON RGY <br /> P PACILITI MANE I C ) , PHONE I <br /> C ADDRESS 5643 E. FREMONT STREET, STOCKTON, CALIFORNIA ( Hwy 26 ) <br /> 1 ---------------- <br /> L CROSS STREITk MILE EAST OF BEYER ON NORTH SIDE <br /> I _ <br /> T OWNER/OPERITOR PHONE I <br /> T MR. VICTOR RATTO (415) 285 7744 <br /> C CONTRACTOR HAMS FALCON ENERGY ASSOCIATES PHONE 1(209) 463 7108 <br /> 0 — _ <br /> Y CONTRACTOR IDDRBSS P,O, Box 30356, STOCKTON 95213 CA LIC 1 584524 CLASS "A" <br /> T ----------------- ---- -- ...--------. ___ ___ _ <br /> 1 INSURER ON FILE WORK,CORP.I ON FILE <br /> C FIRE DISTRICT — PERMIT 1/INSPTR — <br /> 0 WANE r�ATERWORK , ESCALON, CA PHONE 1(209) 838 3507 (BILL CHANNELL <br /> R —— -- -- ----—.— <br /> SENIOR GEOLOGIST <br /> TM�8 SAMPLING ME1dODTPN—G,BTXBF <br /> --------rc�-0v-mD ' --- <br /> TINK 10 1 TANK 9118 CHEMICALS STORED CURREITLI CHEMICALS STORED PREVIOUSL <br /> 7 1000 GALLONS .--_ APPROX. 50 GAL GA GASOLINE <br /> — -------- <br /> 39- — <br /> LIST ADDITIONIL TINX INFORMITIOY IS NEEDED ON SEPARATE PORN <br /> WWNWtlIUtlWYIYButlWWYWIWNWtlIUWWWNUWtlUWRW1 YWUWWUIIWtlIWWIWtlWWIUWIWUIWHWUUtlUWUUUIWUWIUWUWUtlIWYWYWNItlIWUWWUWYYUIWIUUIWUWUtlIWUUWUWWIWUIWWUWBYWUWWIIWUWYDIWIUIUIWIWtlWUWW <br /> P __ APP10V¢D _ APPROVED WITH CONDITIONS DISAPPROVED <br /> L �V��� 8 ATTACHMENT WITH CONDITIONS) <br /> l PLAN RBVIIWERS NINE 'L ���-� � ---- D1t9c --- <br /> N -- � <br /> YIWWNW WIIWWMUAIIIWIWUUWUYYtlYNUWWUWYWYWWWWWWIUtlWWWWNgWWWUUYWYIWIWUNWWNWWYl1NWWWYWWWUiWUWU HIWtlW <br /> IPPLICINT MUST PERFORM ILL YORK IN ACCORDINC¢ WITH SIN JOAQUIN COUNTY ORDINIMCES, STATE LAYS, AND RULES AND REGULATIONS <br /> OF TNR SAY JOAQUIN LOCAL HEALTH DISTRICT, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCI OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MINNER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAYS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES INK <br /> FOLLOWING: 11 CERTIFY THAT IN THE PERFORMING¢ OF THS WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJRC <br /> TO WORKYR'S COMPENSATION LITS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANC�E,���/ fy,� <br /> SIGNED ( —DITE_��� <br /> 0 S9 ON A 7J 016 12 1 <br /> SS SSSS SSSSSS SSSSSSSSSS SSS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSISSSS <br /> SWEEPS II—I COMP I - LOC COD¢ ( DIST CODE AMOUNT DUE l- AMOUNT RCVD �- CK If I RCYO BY -�- DdTE RCVD <br />