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0 00 <br /> Jim Thorpe Oil , Inc. <br /> 351 N. Beckman Road • P.O. Box 357 • Lodi, CA 95 <br /> (209) 368-6175 0 (209) 462-4581 <br /> Contractor's License #495699 <br /> !-EALTH <br /> PERNA11 SERVICES <br /> San Joaquin Local Health District <br /> 1601 E. Hazelton Avenue <br /> P. 0. Box 2009 <br /> Stockton , CA 95201 <br /> Re: Permanent Closure/Tank Removal Plans <br /> 1 . Owner/Operator: Phone <br /> Facility address: <br /> 2. Parcel plot plan showing tank(s) to be removed attached. <br /> 3. Contractor Name: JIM THORPE OIL, INC. <br /> Contractor Classification: A <br /> Contractor License Number: 495699 <br /> Certificate of workers' compensation insurance on file in your office. <br /> ��. Tank # on plot plan _ Tank Size Products currently or previously stored <br /> 5. Laboratory that will collect soil samples <br /> A signed "Release of Information Authorization" is attache . 1 cite-Zee. ✓ <br /> 6. <br /> Method of di osa of all residual liquid, solids , cr sluddpib �r� <br /> tue <br /> ���7. The`�tan w b��"oa 1 1 m� a ors o °secex losion or to <br /> p g p �' P <br /> levels specified by existing regulations by�� 2�� e _-- <br /> 8. Method of disposal or/),reuse:� G—���s� i' —)--'— — <br />