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. . ..,.i.t�.c,ti t,4i ct 4i GS L{L{t3ti ti•!t c�t;l�l�t;t;t;tkt;=tt tk '�1�i..�1I �)a(f'�Cr �•,�y <br /> t: APPLICATIJ&DR.PERMIT t; SAN JOAQUIN LOCAL HEALTH DI CT t: <br /> I t: UNDER D TANK t 1601 E HAZELTON AVE., STOCY.WCA <br /> t; CLOSURE OR ABANDONMENT t Telephom (209). 468-3420 <br /> t <br /> .:w):O}:YY F}',0`: `:�Y:F]:1�:�]]:!>:1):�}:b {�:p'►]:!YY 3.!]ll'/]:M):Y3:03:! YY. �:►�):!}:Y]: <br /> . . . ... ..... . . ...,. .... . .... . . ..... FEB Q 199' <br /> APF-ICAIION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UND'EMOUHD HAZARDOUS SUBSTANCES STORAGE FACILI-Y <br /> TH:E PEPK17 EXPIRES 90 DAYS FRO?. THE APPROVAL DATE. DO NOT WRITE 1N ANY SHADED AREAS, INDICATEW6diT4MTiqLI]ilErlLT;l <br /> PERMIT/SEWCES <br /> REMOVA,. TEMPOPARY CLOSURE' __-- ABANDONMENT IN PLA'CE <br /> I EPF S'T,-' : �YxuJECT CONT LEPHONE t <br /> ,� <br /> "�.` ` " hfont� Case (20c1) 945—r'.i4�`.: <br /> CASECO ALTM10TIVE I <br /> PHONE t (209) U48-646: <br /> ADDRES? 1025 E. Park Street , <br /> A <br /> CROSS STkE _ Union I <br /> 7I OW8ERIOPEPA1 <br /> OP1�1ont}� Case i PHONE # <br /> I (209) 948-6465 <br /> I <br /> C CONTRACTOR NAME Stockton Contracting Grou <br /> O p, Inc. PHONE # (209) 462-5082 <br /> N CONTRACTOR ADDRESS 1000 N. Union Street CA LIC 1 528156 CLASS A ' <br /> T ' <br /> P. INSURER ON FILE WORK.COMP.# 'ON, FILE r <br /> A <br /> T FIRE DISTRICT STOCKTON PERMIT #lINSPTR PENDING 7 <br /> -� <br /> C LABORATORY NAME Canonie Environmental PHONE # (209) 983-1340 <br /> r � SAMPLING FIRM* � <br /> Canonie Environmental Sere. SAMPLING METHOD Hand and Brass tubes <br /> TANK ID I TANK SIZE CHEMICALS STORED CURRENTL CHEMICALS STORED PREVIOUSL <br /> T 6000 Regular Gas <br /> A 3S-_ 2 =Q1_---------- <br /> N 39- 4000. iese <br /> K 39- <br /> 39- <br /> ~ LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPAP.ATE FORM <br /> P _LL APPROVED _ APPROVED WITH CONDITIONS ___ DISAPPROVED <br /> -- --(SEE ATTACHMENT WITH CONDITIONS) <br /> � A PLAN REV(E1;:RS NAME <br /> -� _•� f, <br /> ------------------------------ <br /> ----------------------- DATE---�=l� ----------------- <br /> A - <br /> APPLICANT MUST PEkFORM 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, 1 SHALL HOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br /> SUBJECT TC WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING S16HATURE CERTIFIES THE <br /> FCLLOWING; 'i CERTIFY THAT IN THE PERFORMANCE OF THE W024: FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS 5UBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> ff-11 <br /> FO INSPEC IONS AT LEAST 48 HOURS IN ADVANCE <br /> _ _____--__- ----- -------------------------- -----------Y--E 13 4�b 11188 ------_'-_-- ------ <br /> f33 "s OfffSS3# LDC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CK#/CASH I RCVD BY DATE RCVD PERMIT # <br />