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t r t tt kt tt kt...V tt ttt'k3 tt Lt tt ti:tt'tt ti:tt:tt!ti:tt'ti:tt ti:ti,t t tl <br /> APPLICITION FOR PERMIT SAN JOIOUIN LOCAL HEALTH DISTRILIt: <br /> t: UNDERGROUND TAN( t: 1601 E HATELTON AVE., STOCKTON CA <br /> t: CLOSURE OR ImOORNEIIT t: Telephone (2091 468-1420 ��- <br /> ttrtt�tt�tt�tt.tt�tt tx tt ttt tt tt tt tt tt tt tt tt tt�tt tt tt tt tt�tt�tt tt tt�tt�tt�tt�tt I;� <br /> IPPLICATION FOR PERMANENT/TEHPORIIT CLOSUf1 OR ABANDONMENT IN PLACE OF UNDERGROUND H1112DOUS SUBS?" S� 0 GE FACILITY <br /> THIS PERMIT WIRES 90 DAYS FROM TILE APPROVAL D119. DO NOT 1117E 19 111 SIIA011 AREAS. INDICATE PERMIT 9jk1 �p,L1H <br /> N'VI <br /> XX REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLICB PI:f� IT I SERV4CES <br /> EPA SITE ! CAC000193991 <br /> F FACILITY NAME RAINBO BAKERY PHONE 1— PROJECT CONTACT ri TELEPHONE ��51��(� ('�� if <br /> /Q r <br /> C ADDRESS 108 EAST WALNUT STREET, LODI CA 95204 <br /> 1 <br /> L CROSS STREIT ALLEN DRIVE <br /> I --- <br /> I OWNER/OPERATOR CAMPBELL TAGGART, INC. PHONE 1 618/281-7173 HANK BELLINA <br /> I <br /> C coNlRlctoR N1NE RAMCON PHONE I 916/372-7535 -�--------- <br /> a <br /> N CONTRACTOR ADDRESS P.O. BOX 1024 W. SACTO CA 95691 CA LIC 1 510034 CLASS "A" <br /> 1 <br /> R INSURER STATE FUND YORK.CONP.1 570-88-2318 <br /> C FIRE DISTRICT LODI FIRE PERMIT I/19SPTR <br /> - <br /> 0 LABORATORI NAME I .T. LABORATORIES P1falle ! '13/921-9831 <br /> SAMPLING FIRMA I .T. LARORATORIES SAMPLING METROD 5030, 8020, TEL 8 EDB <br /> — EUHI;I�IUlklullLOtlIEIfRRGWNtiIUIIIVI.i�t�'JIV91iCCR0l7,�tYiltUdtllrgl ------- -----.---- — — -- <br /> TANK ID I TIKK S119 CIIEHICILS STORED CURRENTLI CIIEMICALS STORED PREVIOUSL <br /> t <br /> A <br /> 39- �� 0 f - --- - 1 ,000 GASOLINE <br /> TANK WILL BE DISPOS D OF AS SCRAP - TR ANGLE CONSTRUCTION <br /> 39- ----- - SACRAMENTO <br /> - �- LIST ADDITIOMAL 119K INFORMATION 15 NEEDED ON SEPARI19 FORM <br /> NIiICNWll11O1'IVttlGllilH�91YiNIRIIki1Y7�NJ9lllll�fllllWEllyltU. Iltll Ili�llRlllUlilGtI�IIRkplNil3'd11k"SKI',�Ilp'�fi!llllC"IO!I1RlgEB'BfNikSkOlnJAI;IYlUpllllilYY9�>�;'ill'�;K�'�gllU'A�1y111:�ILy183111Q1@IlbdlIIIORIRIIp.'IHllVIu'RI�RIN4l„I}k41VIRP � <br /> P L_ APPROVED —_6PPROYED PITH C ADITIOMS DISAPPROVED <br /> L (SEE 17TAC ENT N N CONDITIONS) <br /> A PLAN REVIEWERS MINE 1�-� <br /> A t[ `---- <br /> RI11l�lIfRMJ�11O1D�M�If11 11O1i111�If�11MfNINO0KI11I1111�11 UI➢IIIIMIIfRIIIWBI IIIRIRRIl�11�l�IIf1R1II�fOB <br /> 1PPLICANt MUST PERFORM ILL YORK IN ACCORDANCE PITH SAN JOI IN COUNTY ORDINANCES, STATE LAYS, AND RULES 190 REGULITIONS <br /> OF THE SAN JOAOUIN LOCAL HEALTH DISTRICT. OYNER OR LICENSED AGERT'S SIGNATURE CERTIFIES THE FOLLOYING: 'I CERTIFY THAT <br /> 19 THE PERFORMANCE OF TME YORK FOR YHiCH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOT ANY PERSON IN SUCH MANNER AS TO BECON <br /> SUBJECT TO YORKER'S COMPENSATION LAYS OF CALIFORNIA.' COHIRACTOR'S HIRING OR SUBCONTRACTING SIGHITURE CERTIFIES THE <br /> FOLLOWING; 'I CERTIFY THAT IN THE PERFORMANCE OF THE VOf( FOR YHICII MIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO YORKER'S COMPE951110N LAYS OF CALIFORNIA. _ <br /> C2'LL I-OR IPISPEJCTIOtIS AT LEAST 48 110URS I14 ADVANCE <br /> 51GHE0 DATE //f/c�fc3 <br /> OFFICE USE ONLY—E[1 23 0+16 11/11 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSISSSSSSSSSSSSSSSSSSSSSSSSSSSSSiSSSSSSSSSSS3SSSSSSSSSSFSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSISSSS <br /> STEEPSiI COMP—I LOC CODEDIS1 COOS' 1MOUNT DUB AMOUIIT RCVD I CKI/CASII RCTO BY 0119 RCVD PERMIT 1 <br />