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ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br />XX REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br />EH 23 046 (Revised 7/10/92) <br />Page 3 <br />EPA SITE #CAC000965360 <br />PROJECT CONTACT & TELEPHONE # Thomas Murray -91 6-381 -1600 <br />F <br />A <br />FACILITY NAME RTR Facility, Stockton Metro Airport <br />PHONE # <br />209-946-6310 <br />C <br />I <br />ADDRESS 5000 So. Airport Way, Stockton,Ca. 95206 <br />L <br />I <br />CROSS STREET Arch Road <br />T <br />OWNER/OPERATOR <br />PHONE # <br />Y <br />U S DEPARTMENT OF TRANSPORTATION <br />916-551-3406 <br />C <br />0 <br />CONTRACTOR NAME ARONSON ENGINEERING,INCORPORATED <br />PHONE # 916-381-1600 <br />N <br />CONTRACTOR ADDRESS 6809 McComber Street <br />CA LIC # <br />59201 0 <br />CLASS A-Haz <br />T <br />R <br />INSURER Golden Eagle <br />WORK.COMP.# PWC 182 378 <br />A <br />C <br />T <br />FIRE DISTRICT Montezuma <br />PERMIT # <br />9400228 <br />0 <br />R <br />LABORATORY NAME Cal Test Napa <br />PHONE # 707-258-4000 <br />SAMPLING FIRM R M C I Lakewood, Ca. PHONE #303-969-8778 <br />TANK ID # TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br />39- <br />T <br />39-_ 16 v l - C7 <br />5UU qa­F <br />clieselunk <br />A <br />39- <br />N <br />39- <br />K <br />39- <br />39- <br />39- <br />X77 F <br />L <br />X APPROVED APPROVED WITH CONDITION(S) <br />DISAPPROVED <br />N <br />ACHMENT WITH CONDITIONS) <br />PLAN REVIEWERS <br />NAME Zf' <br />DATE C. <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br />THE <br />PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH A KANNER AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br />"I <br />CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, <br />I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA."' <br />APPLICANT'S SIGNATURE:_--i%i5%�-1Y/ %�� L/ Il/il TITLE- —1 <br />� <br />SSS C DATEZ/1/99 <br />EH 23 046 (Revised 7/10/92) <br />Page 3 <br />