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APPLICATION FOR PERI SAN JOAQUIN LOCAL LTH DISTRICT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone (209 ) 468-3420 RD <br /> IPPLICITIOV POR PIRIAIIIT/TIMPORIIT CLOSUII 01 IIAIDOIMIIT 11 PLACE OF UNDERGROUND 11111DOUS SUISTAICIS STORAGE FACILITY <br /> THIS PERMIT IIPIIES 10 BITS 1101 TIL 1PPROTIL DATE. DO HOT IR1TI IN All SNIDII AREAS. IIDICITI PERMIT TTPI BILOT: <br /> x_ REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT369-1132 <br /> A George Gemellos , I PHONE # 205L� <br /> C FACILITY NAME IDLEWILD ADDRESS 3049 W. Hwy 12 <br /> I <br /> L CROSS STREET DEVRIES RD. PHONE #_229/ 369-1132 <br /> I <br /> T OWNER George Gemellos , I PHONE 1209 / 369-1132 <br /> Y <br /> C CONTRACTOR NAME George Gemellos, 'I PHONE 1209 / 369-1132 <br /> O <br /> N CONTRACTOR ADDRESS 3049 W. Hwy 12 CA LIC # <br /> T <br /> R LIC CLASS WORK . COMP. p INSURER <br /> A <br /> C FIRE DISTRICT Woodbridge PERMIT 0 <br /> T <br /> 0 LABORATORY NAME c L �r PHONE p D' / 1 <br /> R <br /> SAMPLERS NAME SAMPLING METHOD <br /> C 1IRM VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID I CURRENTLY PREVIOUSLY <br /> E <br /> M /Li -G I 550 Gal Leaded gasoline I TOU"� Leaded gasoline <br /> I TO <br /> C TO <br /> A TO <br /> L LIS ANY EXTRA TANKS ON A SEPERATE SH ET <br /> P 101JRUVEL) Lll� �W 11 �V ON RUINID TlUuib <br /> L (SEE ATTACfWEN ITH CONDITIONS) / <br /> A PLAN REVIEWERS NAME4�rY DATE <br /> N <br /> APPLICANT MUST PERFORM ILL fO1I 11 1CCORDIICI PITH $11 JOIOUII COUNTY ORDINANCES, STATE LIES, 110 RULES AND REGULATIONS <br /> OF THE SAN JOlDU11 LOCAL HEALTH DISTRICT. OFIRR OR LICENSED 19111'S S1G11TURE C1111FIES Too POLLOYINC: 'I CERTIFY MIT <br /> II THE PRRFORM/ICE OF TBI Yogi 101 FILCH THIS PERMIT IS ISSUED, I SHILL NOT INPLOY III PERSON IH SUCH NIMMEI 1S TO 1ECOME <br /> SUBJECT TO EORIMII'S CONPII317101 LIES OF CILIPOIII/.' COITIICf0I'S IIIING OR SUI-COHNICTING SIC/ATUIE CIINFIRS THE <br /> FOLLOGIC: 11 CBRTIIY TEAT IN TBE PIR/ORMI/CY OF THE PORE FOR FIICI THIS PERMIT IS ISSUED, I STILL IMPLOT PERSONS SUBJECT <br /> TO fORIMII'S COMPENSATION LIES 01 CALIFORNIA. CONPLITE DIMING 01 Iff1CHED PLOT PLAN SHEAT. <br /> CALL 17R ALL ,NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SIGNED X c'z-Z ( �� TITLE: DATE: 1^ `/1%- 6,� <br /> 7 0 7� <br /> ACCEPTED BY ' � -C TITLE: C \ DATE:/ ?- <br /> MINIMUM 1 11 <br /> 'MITTEL) RTC <br /> ' "ID'DIC6TA <br /> �� <br />