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k1WR:L1-k4Pn n,. tii k1 li L'1L'1 ti L'i n ti MLi Ci 11'l'fiC1 t1 E1 tt t1 1 <br />APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICTt: <br />t: UNDERGROUND TANK t 1601 E AAIRTOR AVB., STOCKTON Cit: <br />t: CLOSURE OR ABANDONMENT t: Telephone 12091 468-3420 e <br />r ff t1: fft1't4 L111: tilt: M L'1'M1C L'i: L'y til1-ti: ft L:v tyrt: Mtl� tt: ki:R., ff tZ R till: <br />9 Q e rj <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br />?HIS PERMIT HKPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN III SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br />METHOD OF CLOSURE 37D BE DETERMINED — <br />- /REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br />EPA SITE t� �iDODj ��Z j — <br />PROJECT CONTACT A TELEPHONE I Sandra Getz (916) 440-494 <br />Associate Asset Manager <br />F <br />A <br />FACILITY MAKE Denevi <br />PHONE I N/A <br />---— <br />C <br />I <br />ADDRESS 5555 Shippee Lane, Stockton, California <br />--- <br />L <br />I <br />CROSS STREET <br />T <br />---- <br />OWNER/OPBRATOR Wells Fargo Bank, Trustee <br />— <br />PHONE 1 (916) 440-4941 <br />i <br />C <br />CONTRACTOR RAMS See cover letter <br />PHONE I - -- --- <br />0 <br />- <br />I <br />CONTRACTOR ADDRESS <br />CA LIC I <br />CLASS <br />T <br />----- <br />R <br />INSURER <br />WORK.COMP.I <br />A= <br />----- —_-------_— <br />- ---___ -_---_ -- <br />C <br />FIRE DISTRICT San Joaquin County <br />PERMIT 1/IMSPTR 89-0081/Cunningham <br />T— <br />----- — <br />0 LABORATORY NAME PROMS I <br />R <br />SAMPLING RK' SAMPLING METHOD <br />--Iil1IIIIBNH!iNllli!IiNINCiINI��!111111iIIIIIIIIIIIiNIIIIIIIIiIIIIIIINpBIIIIIIliI111111111NNNI — —.— <br />TANK ID 1 TANK SIZE CHEMICALS STORED CURRENTLI CHEMICALS STORED PREVIOUSL <br />INV <br />T <br />A— <br />N 39- —_-- <br />1 39 --------- -- -- <br />J 9 --- <br />-ill LIST ADDITIONAL TANK INFORMATION AS NEEDED 09 SEPARATE FORK <br />IN1111iIIIHIIIIIIINUIIINbU1111HllNIIINIIIIIISIINNIINIINIIIV1911NIININIENNIIIIUI. HIWNIIDDIIIINIIIIIINNIMIRIIIIIIIIIIIIINIIIIIIININUII1111iIIIIIIINIIIIINIIIIIIINIWIIIINiIHIIIIIIINNIIIIIIIIIIIIINIIBNINIIIINIIMIIIINNIIIIIIIIIIIIIIIIIIII11111NINHNIIIINDIINIIiHIIININNBINlHIIIVIINIIIIIINIHIIINIIIIIII.INIRYIIIINN <br />P If APPROVED WITH CONDITIONS DISAPPROVED <br />_-APPROVED _ <br />L i (SEB ATTACHMENT WITH CONDITIONS) - <br />A PLAN REVIEWERS NAME DATE <br />iBIiIIWYI�IIII111W1N@II �IIMINNIIINIIpItldNIINININIiNCINIININNNNNNINIIItiIINRNIIINIIIRIIIDIHIIKDIWIIININRBIIII%11111111111WIIIIIRSINIMHINIIIIIIHNCSIUNIWIINRNIpIIIlI1111NIIIVIH@NNIINNIiIIINNIIIINBNIIWIIIINIIINIINIINNBIYRIYIIINIBIBINIIIMIINIIINIIINRNIIIIIIIIRHNIINNIHIHIW i � <br />APPLICANT RUST PERFORM ALL WORN IN ACCORDANCE WITH SAN JOAOUIN 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 PEP.FORMANCR OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO DECOR <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES TNS <br />FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 13 ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br />TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br />CALL FOR INSPECTIONS <br />NS ECT I., AT LEAC IN ADVANCE <br />Wells FargoN.A., Trustee <br />� <br />SIG <br />� J <br />OFF1 N USE 0 Y --EH 23 046 I• AS GA.SHUPE T'--- <br />SSSS9SSSSSSSSS6S9SSSSS9SSSSSSS493SSSSSSS943SSSSSSSS9SSSSSiSS4SSSSiSS����S�S�9���SSSSS9SSSSSSSSSSSSSSS4SSSSSISSS9 <br />RWBSPS 1 I COMP I �ILOC CODE DIST CODEJ AMOUNT DUE AMOUNT RCV0 <br />11L" CKI/CASE � RCVS �TIwV� PERMIT I <br />