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t: CLOSURE OR ABANDONMENT-• -" " <br />Telephone (209) 40-^420 <br />>:»:n:w:uxrrra.rvrwr:n:rr:rs:ra:n:n:n:a:a:r>:rr:, rrp•rxrr. ` <br />IR PERMANENT/TEMPORARY CLOSURE OR ABAHDOHMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES S', <br />IPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE 1N ANY SHADED AREAS, INDICATE PERMIT it <br />GDEMOVAL _-__- TEMPORARY CLOSURE <br />_ ABANDONMENT Ik PLACE ` <br />PROJECT CONTACT E TELEPHONE I` S <br />IESzrq q48 <br />T11 1 C moi(_ t<� 1PHONE I <br />yew ( Zo(o <br />(n 1 = ,--,- n _ <br />it <br />1.1 <br />IBdWI <br />APPROVED <br />—C <br />_OCD --I1Z <br />PHONE i <br />CA LTC I CLASS ' <br />WORK. COMP, I q u <br />PERMIT 11IHSPTR <br />PHONE ! <br />SAMPLINGMETHODE"c'�`'A"'cam <br />_ <br />TANK SIZE CHEMICALS STORED CURREHTL CHEMICALS STORI <br />m <br />u --s <br />CA <br />ED WITH CONDITIONS...-,._ _:-DISAPPROUE0 <br />IMEN WITH CONDITIONS) <br />/ <br />-------------------- DATE ---- <br />/ ------=------ -- <br />I�IIVHnY�IWtlu0W011eNoi r� . i rcni i- u n i • <br />FORM ALL WORK IN ACCORDANCE WITH SAH JOAQUIN COUNTY ORDINANCES, STATE -LAWS, AND RULES AND REGl1C,UTI9 <br />LOCAL HEALTH DISTRICT, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIF( T}U <br />WORK FOR WHICH THIS PERMIT 1S ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECO <br />i COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIF1ES.THE; <br />FY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBIEi <br />ATION LAWS OF,CALIFORNIA.. <br />INSPECTIONS AT LEAST 48 <br />HOURS IN ADVANCE - <br /><3 <br />! -�c-arc_- __----I _------ _ � <br />23 014 12/88 ' ----� �_e'it'n,,_DATE___bn I �{© <br />�fSStfSfSffSifSffftSffSSffSfSSffSfffffSfSfffffSffffSfffSfSfjfSfffffSrfffSfSisSifSSffSfiSStifsfff;ftfSS <br />OC CODE I DIST CODE AMOUNT DUE AMOUNT RCVD I CK11CASHRCVD BY <br />—__ L L I DATE RCVD PERMIT J <br />_ <br />