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OTONENGINEERING +. <br /> 9169240811 <br /> P. 04 A•+• <br /> MAR, 15 '93 03117PM ULTRAMAR INC. & <br /> T <br /> P.4i16 , <br /> sal <br /> a•�f <br /> i- <br /> ENVIRCMMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> APPLICATION FOR PERMAN{NT/T <br /> THIS PLAMIT EXPIRES 90 OAYYS FRCCM HE AURE OR AOANDp17}ENT TN PLACE OF UNDERGROUND N <br /> THE APPROVAL DAT{, DO NOi WRITE 7N ANy SHADED ARGSR�g SUBSTANCE STORAGE TANK <br /> INDICATE PERMI7 TYPE BELOVt <br /> REMOVAL TEMPCAARY CLOSURE <br /> EPA fO( # �. � CLOSURE IN PLACE <br /> ,te 1. oo 0 PROJECT CONTACT { TELEPHONE Y <br /> F FACILITY NAM %YAC v� <br /> 47 <br /> ! AGGRESS � PHONE Y <br /> iL CROSS i)REIT r�---• <br /> I JiGA✓trp �'^�.'v f' <br /> T O.71ER/OPe T <br /> T p/� <br /> c..J— ��4'r�yyq 2/ -..�•' . PHONE Y <br /> C CONTRACTOR NAME �""� �/ - .$�"S `•�.S`7� <br /> N I CONTRACTOR ADDRERS �. O �o Ll E 6 tZ I NL( �C L PHONE S <br /> / O Z r' W. ShcTo CA LIC N <br /> INSURER �. _ `�" 9564 231- CLASS $ <br /> C FIRE DISTRICT "rOG1Ct-Ot,� Ia NCRL.CCMP.y U Q O Zr r ZR L O p6 <br /> 7 `SjI sr <br /> 0 CABOµ70RY�NAIIp�' PEAIIl7 M <br /> R <br /> tAMPLJNa F1AA�`-� A, L — l,.L/ l S PHONE 0 <br /> R�1 yt C'7'O r., � <br /> rrrrnrrn 1 r r rrrrrrnrr iCLI-:-L 5o a PHONE N <br /> 39• / TANK SIZE <br /> T 39• oar, CHF117C'A.3 STORED CURRENTLY/PREVIOUSLY <br /> A 39• /� <br /> „L ,.�� _ u DATE UST 10TALLED <br /> N 39• �'-•�r _ <br /> 39- <br /> 39- <br /> P <br /> 9•39-P nu -- <br /> LAPPROVED <br /> A ...._ APPROVED Y1TN CONDITION(S) <br /> N PLAN NFVIEMLRB NAME (SEE ATTACHMENT WITH CONDITIONS) OiSAPFROVED <br /> fill fill IIUr1Urrlr <br /> DATE <br /> fill <br /> APPLICANT MUST FERFCRN ALL MONK IN lrrrr <br /> SAN JOAOUIN COUNTY THE <br /> MIALIN SERVICES.N OkMLlt WITH <br /> JON&NINA COUNTY <br /> 9 SICNATURI CLRTIFILt THE FOILOMINCt n <br /> THE PE, ORDINANCES, STATE LAMS, AND RUIEf AND REGULATIONS OF <br /> PFCRMANCE OF THE i3ORK fOlt WHICH THIS PERNt) II ISSUED, I /HALL NOT EMP <br /> SUBJECT TO MOR"916 OCIMIATION U LOY ANY PER8O1 7 CERTIFY THAT (N <br /> 'SUBJECT CEAT7FY THAT IN TN{ PERFORANANCE 01 THLG�71iK FpjAyNICNTH 1 [KNIT IS 7LlUE0, i SHALL LMPLOYIGNATURE CIRTIFT TO HI R AS TO OLL <br /> TRACTORiB HIRING CA SUI SHALL <br /> SIGNATURE CERTIFIES THE FGLLOMI NDt <br /> COMPLN1Ai{ON LAWS AF CALIFORNIA -. <br /> Ail <br /> APPLICANT'S SIONATURSt .. ��� <br /> AcL7"o �� � � - TITLS �fLE.Stj�F r DATE 3 Ni/3 <br /> tai, t r.t. <br /> 23 046 (R►V <br />