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to ti tt ti:ti kt ti:ft tit:ft ti:ft 0tt tt it:ft ti:ti.ti:a Ve killit*ti: tttt <br /> tY kt <br /> APPLIA FOR PERMIT N 311 JOIQUIM LOCAL IBILTH�RICTk: <br /> k: UNDERGROUND TANK t: 1601 8 HIIRLTON 178., STOCKTON C1k: <br /> t: CLOSURE OR ►IINDOINENT t: Telephone 12091 161-3620 t: <br /> "111:kill:tt fftt ti:tt tit'kt tv tt kt Or tt ttm eF R:ft tilt-ti:tt-tt.ttql4l.ti:tt.tt:tt <br /> APPLICATION FOR PERMANBYT/TEMPORIIT CLOSUII OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT BIPIIES 90 DAYS PROM THE APPROVAL DI?8. DO NOT 1111E IN 111 SHADED AREAS. INDICATE PERMIT TYPE IBLOW: <br /> — REMOVAL _—_ TEMPORARY CLOSURE — ABANDONMENT IN PLACE <br /> EPI SITE I Ll ' cJ/ ( PROJECT CONTACT A TELEPHONE 1 CurlRowley ---_-- -- <br /> D I _ y <br /> 1 FACILITY tl1M6 San Joaquin Lsnber Co. PHONE I (20))46651 _ <br /> C ADDRESS <br /> I 235 Scotts Ave. Stockton, CA 95203 <br /> L CROSS STREET <br /> I Lincoln <br /> 1 OWNIR/OPERATOR PHONE 1 <br /> 1 Curl Rowley _ (209)465-5651 <br /> C COYt11CT0H Y/X8 _ `---_---= PHON61 --��—_--'=�=T�Y—=�=___ <br /> O We dQu, Weldon, & Cowell (209)874-3722 <br /> 1 CONTRACTOR ADDRESS CA LIC I CLASS <br /> Hickman CA 95323 566216 B C-36 <br /> I INSURBI WORK.COMP.1 <br /> 91_127 <br /> C PIRG DISTRICT _ PERMIT I/[YSPTI ---__�- __— <br /> T Stockton <br /> 0 LABORATORY 1AM6 California Water Labs PNOYB I (209)527-4050 <br /> H _ <br /> SAMPLING FIRM' SAMPLING METHOD <br /> WDtWYYINWDWtIDWNWY1kWItWgWWDINIWINY - _ _ __ _ <br /> ?INK 1D I TAKI S128 CHEMICALS STORED CURRENTL CHEMICALS STORED PRIVIOUSL <br /> T _ E <br /> ! G - -- <br /> Y 39-=h �--- <br /> I 39- _ <br /> - — LIST ADDITIONAL TANK INPORHITION AS NEEDED ON SEPARATE PORN <br /> WWWWNWIRWYkWIRWWWYWWIWWWWRWItWWWYWRWWIWRWi IWWIIIWWIWWWWDII;WADI'JWWIIDWi!WIIJDWWItWtDtWL'YWN!WWWWWWDWYDJWDWWIWWNWUtDWWW7!WWW:IWIDDGWWWiWIWWWdDDWWIWDWIWWWWJNDWI!IWWIYW ' ' <br /> P APPROVED _APPROVED WITH CONDITIONS DISAPPROVED <br /> L (SBE ITTICHMEHT WITH CONDITIONS) <br /> 1 PLAN REVIEWERS NAME <br /> WtlWYWWWWWWWIYtlYtlYWWWRY <br /> APPLICANT MUST PERFORM ALL WORK 11 ACCORDANCE WITH SIN JOAQUIN COUNTY ORDIIINCES, St/TE LAWS, AND RULES IND REGULATIONS <br /> OF THE SAN JOAOUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CERTIFY THAT <br /> IN THE PERFORMANCE OP THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL 101 EMPLOY ANY PERSON 1N SUCH MANNER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY ?HIT IN THE PERFORMANCE OF THE YORK FOR WHICH TEAS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJIC <br /> TO WORKER'S COMPENSATION LIVS OF CALIFORNIA. <br /> CALL POR INSPECTIONS AT LEAST 40 YIOURS IN ADVANCE q, <br /> SIGNED , <br /> OFFICE US8 811 13 016 12/11 - <br /> SSSSSSSSSS +SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSs'SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS <br /> SWEEPS-1 -COMP I- 160C CODE ( DIST-CODE' IIMOUUB- - CK - BY —D/TE RCVD PERNJIII <br />