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tott0:t1: tttttttt.tttttttattttrtstttttttttttttttttttttttttttvtvtt <br />t: APPLICATION FOR PERMIT t SAN JOAQUIN LOCAL HEALTH DISTRICTt: <br />t: UNDERGRTANK t 1601 E HAIELTON AVE., STOCK.T t <br />t: CLOSURE 0 NDONMENT t Telephone (209) 468-342OW <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. OD NOT WRITE IN ANY SHADED AREAS, INDICATE PERMIT TYPE BELOW: <br />__X REMOVAL _____ TEMPORARY CLOSURE _-__ ABANDONMENT IN PLACE <br />an <br />CAC 000254993 PROJECT CONTACT 6 TELEPHONE t Doyle Judd <br />_I <br />(209) 887,-3556 <br />FMEEquitable <br />LFACILITY <br />Life -Shelton Road Ranch PHONE 1A (209) 887-3556 <br />1 <br />1 <br />25499 E. Shelton Road, Linden, CA <br />_..--.--- <br />L <br />I <br />-- — — <br />CROSS STREET Escalon-Belota Road <br />T <br />OWNER/OPERATOR Equitable Life -Equitable Agri <br />__ _ <br />PHONE t (415) 935-9172 <br />Y <br />Bus'ness <br />2700 Ygnacio Valley Poad, Suite 315, Wa�nut Cr <br />ek, CA 94598 <br />C <br />CONTRACTOR NAME Jim Thorne Oil, Inc. <br />PHONE 1 (2 09) 941-1444 -- <br />0 <br />---- ----- <br />N <br />CONTRACTOR AODRESS 351 N. Beckman Road <br />— <br />CA LIC 1 495699 <br />CLASS A, Haz. <br />I <br />— <br />P <br />— <br />INSURER on file <br />WORK. COMPA on f i l e <br />C <br />FIRE DISTRICT San Joaquin County_—IPERMIT <br />t/INSPTR <br />0 <br />LABORATORY NAME FGL Environmental <br />— <br />PHONE t (209) 942-0181 <br />P, <br />— <br />_ -- <br />SAMPLING FIRM, Same SAMPLING METHOD brass tube -see #5 on removal I1 <br />— YnYNtOPo11YIrYYNOYIYY�IYYDW001L�1YCN®YIYNtlYWI -- <br />TANK 10 1 TANK SIZE CHEMICALS STORED CURRENTL CHEMICALS STORED PREVIOUSL <br />T <br />A 33 Y3(—/ 10,000 diesel <br />N 39 --------------------------- <br />K 39 —_- <br />--------------------------- - <br />39 --------------------------- — <br />LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br />nIDIIDION® pppYMl'OLNIIWtlYINOm101YDtIWVAHeiItlEYtlWVIB�IfiWtlllpNPgtlIRUNO�YttWYWCANFtlIt11BW@I0'IBVItINOWWNWWYAWY0�8Y1Yg11pOwWNpYtlta0W1YYAAANMI� <br />P _'_ APPROVED APPROVED WITH CONDITIONS DISAPPROVED <br />nJ5EE A T IMENT WITH CONDITIONS) <br />A PLAN REVIEWERS NAME <br />(�{t� DATE____11b�9ti <br />-- �� BWAWCBUBNItlONnIIYY�WINpIVI�NJNpIBflINRINIPIINNXOtlW01RYIP�IYIYpIDIXQ8BWI1ppYNBRpDNyYYGpYIiNNYYRp1YYMBIIDYGYVpIROXYRRpDIIIWWNIOmWON70NWY <br />APPLICANT MUST PERFORM 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,; '1 CERTIFY THAT <br />IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br />FOLLOWING: '1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br />TO YORKER'S COMPENSATION LAWS OF CALIFORNIA. <br />CALLzf IN ONS AT LEAST 48 HOURS IN ADVANCE <br />/ <br />_e= !_ President 15, 1990 <br />IGNED vity-411 <br />_'________ - _____DATEMarch <br />OFFICE US13 016 11/88 -"-" <br />{ff{{{t{ffffifl{f►ffff{ffffffff{f{fffff{fffffffffftfffff{{tfffiffffff{fffftfftfifffff{iffffS{fiff{fffffff{ffiftffffffitf <br />NEEPS t I COMP 1 ILOC CODE JOIST CODE AMOUNT DUE AMOUNT RCVD CKVCASH - RCVD BY DATE RCVD —PERMIT 1 <br />an <br />