Laserfiche WebLink
t�ti�ki�ti'k�i�ti'tti ti�tii�tiki:t}:ti:ti�ki'ki�ti�ki'k}:k}:kiL•}:ki�ki�ti�t �t}:ti:ki� <br /> e APPLICATION FOR PERMIT p SAX JOAQUIN LOCAL HEALTH DISTRICTk: <br /> p: UNDERGROUND TAN[ p: 1601 E HI[ELTOX 17E., STOCKTON CAP: <br /> p: CLOSURE OR ABINDOMMENT p: Telephone (209) 168-3120 p: <br /> t k}:tial:ti:ki:R:ti.,ti:ff kill ki:ti:ti:ff ty tf ti:ff ti:t}:ff ff t}:ti:tir kY ki:ti:tk-ti:t}:ti. <br /> APPLICATION FOR PERMANENT/THXPORIRY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HIZIRDOUS SUBSTINCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT 11118 IN 111 SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> ZC REMOVAL --- TEMPORARY CLOSURE _ IBAYDONMENT IN PLACE <br /> EPI SITE 1 C ()0U 1 J q0 3 L PROJECT CONTACT [ TELEPHONE IAP I Ko k'DJC 7 2 <br /> F FACILITY NINE U'Conlnl©K WOODS _ PHONE 1 aOl y76 -1973 <br /> A <br /> 1 ADDRESS <br /> 1 �900 WAGNHE-76HTS kJ STOCK T oAJJ CA- <br /> L L CROSS Still? g �1NBRiD � WA-bfy) �/\/ <br /> 1 — _ <br /> T OWNER/OPERITOR C©rio(wz- Wvob S �t C . PHONE I <br /> I � o S% )OsCPHIS HEALTH C"E CORP, a°1 `f67-63 5 <br /> c CONTRICTOR NINE WOLIPJ -� SONS /J PHONE I <br /> o dO ,q6 7-9 <br /> N CONTRACTOR ADDRESS �® BOf eK CI Ll t 36 5 p CLASS �} <br /> T -- <br /> R INSURER TA—( E FVN� NSUFftNfRLCOKP.l <br /> C FIRE DISTRICT CT�CI< r0,,pW, SwE ✓ PERMIT I/[NSPTR-- --- _ <br /> T <br /> 0 LABORATORY NAME CLIA fM/f1LyjKhLA�/ET✓Flo PHONE I — <br /> SIMPLING FIRM KL ElAIF-L EK4- ASSOC• SIMPLING METNOD <br /> — IBIIIIWWVIIIWIWVWIIHIIIWIVWHIIIfIwWYIDIWIHIWVRDDIW18WwVtlDHtl ___ <br /> TANK ID 1 TANK SIYB CHEMICALS STORED CURRENTLI CHEMICALS STORED PRBVIOUSL <br /> 1 39-T _ <br /> _ <br /> C 39- <br /> 79-__-- — <br /> — LIST ADDITIONAL TANK INFORMATION IS NEEDED ON SEPARIT8 FORM <br /> IWIIYIIIViWIDWVWWIWHWINWVWWVtlWHHtlViiNVWWWHWWIWIIDV,IIIWV IIWIVIIIWVIVBIIIIIIIIVIIVDIVOIIWOVWWIIIVIWWIIIVIItlVNVVVIIIVVtVDWVWDVIIWIIIItlV0111WWVVtlwVIWIVIIIVVIIIIWtltlVWWHVVVVWWWWVIIIWWVQIIWWIWIIIwIIIWIWV81111tlWIItwWRIWWV <br /> _ APPROVED IPPROVED WITH CONDITIONS DISAPPROVED <br /> PLAN REVIEWERS NAME <br /> 1 ACHMENT WITH CONDIIIOYS) <br /> DATE / <br /> — DutlwVVwuIIWwWWVIWIWWIWWwWVIWW81uWVVWIIBtluwVuuWWtlIWRIwIIWBWWwuluuuuwWWwVwwIwIWVNVuu uluwuWllwVWluufuuuwuwuWlwWowuwuWWVlluuuWtlDwlwwwwullWlWWuwIIWWWHWwwVtluulVwwwIWWWIVtlWwVWWRIYtWWYIWVIW <br /> APPLICANT MUST PERFORM ILL WORK IN ACCORDANCE WITH SIN JOAQUIN COUNTY ORDININCES, STATE LIPS, IND RULES IND REGULATIONS <br /> OF THE SLY JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 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 YORKER'S COMPENSITION LIPS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT 11 THE PERFORMANCE OF THE 1011 FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJBC <br /> TO YORKER'S COMPENSATION LIVS OF CALIFORYII. <br /> CALL F R INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> IGNBD —ic� j - -- DATE // _ /�_q 6 <br /> OFFICE USB ONLY•-8N 17 016 11/11 — <br /> SSSSS$$S$$$$$SSSSSSSSSSSSSSS$$SS$S$$$SSSSS$SSSSSSSSSSSSSS$$SSS$$$$$SSSSSSSSSS$$$$$SSS$$SSS$$S$$SS$SSSSSSS$SSSSSSSSSSSS$$S <br /> SWEEPS `I COMP I I LOC CODE DIST CODEI IIMOUHT DUB I AMOUNT RCVD I` CKI/CASTE �— RCFO BY—I- 0118 RCVDI PERMIT I <br />