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APPLICATION FOR PERM SAN JOAQUIN LOCAL . ALTH DIST CT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE . , STOCKTON CA <br /> 1 CLOSURE OR ABANDONMENT Telephone ( 209 ) 968-3920 — J <br /> IPPLICITION FOR PIRKINENTITIMP01l11 CLOSUII 01 IBINDONNINT 11 PLICI OF UNDERGROUND NLILIDOUS SUBSTINCES STORIGE FICILITf <br /> TB11 R11T IIPIRES SB DIPS 110H TNI IPPROTIL D1TL DO NOT I11TI 11 111 SBIDID IRE/S. 1NDICITI PIHBIT 71PE BELOW: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT AL KELCLW, PHONE IaO_CL-/ LII�Ie DST <br /> A (� c� <br /> C FACILITY NAME ��r 1p)IS��IfbJTIa� ADDRESS 13 �2© W. W866 ,�L <br /> I <br /> L CROSS STREET �VASk})�f�7D+j PHONE 82 7 (0 -L LV9 & <br /> I <br /> T OWNER PHONE <br /> Y V N 10 rj t Q �Arr,eort'i <br /> C CONTRACTOR NAME S&M CA-) PHONE Y 2DQ-/ <br /> 0 `� <br /> N CONTRACTOR ADDRESS -1,r � CA LIC I y9 864- <br /> T <br /> R LIC CLASS C-6 \ WORK . COMP . IO,j FILL INSURER <br /> C FIRE DISTRICT � 0�� C1� �r�L PERMIT N <br /> 0 LABORATORY NAME C(ALIV-, PHONE tk / 5a�-yob <br /> SAMPLERS NAME�pL,j G <br /> SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID I CURRENTLY PREVIOUSLY <br /> E <br /> M 7 TO <br /> I —TO- <br /> C —TO- <br /> A —TO- <br /> L jjRLIS ANY EXTRA TANKS ON A SEPERATE SHEET <br /> P <br /> L (SEE ATTACHMENT I 1 CONDITI NS) <br /> A PLAN REVIEWERS NAME DATE, _ <br /> N <br /> M <br /> 1PPLICINf MUST Pstr0ll ILL TORI IN ICCOED1NCl II78 111 J010UII COUIf1 010[111CIS, Sflfl LIPS, IND RULES IND RICULITIONS <br /> OF fit III JO10U11 LOCH 11101 DISTRICT. 01111 O1 LICENSED 1CIIT'S SIGIITUHI C1111FIE1 fit POLLO111C: 11 CERTIFI NIT <br /> IN fIl PIHFO/MAGI OF fig YORK FOR INICE THIS Fl1MIf IS ISSUED, 1 SI1LL NOT IMPLOf IIT PIRSOI If SUCH MIN1E1 IS TO BECOME <br /> SUBJICf TO YORIMII'J CONPENSIf101 1.115 OF CILIFORNII.I COIT11Cf0R'S 1111NC OR 1U1-CONTRICTINC SIGNITURI CIRTIFIIS THE <br /> POLLOIIIC: 11 CERfIFf TfIf 11 118 PERFORNINCE OF THE FORK FOR 111C1 THIS PER1lf IS ISSUED, I SHILL 81PLOY PERSOIS SUBJECT <br /> TO IOIIIII'1 COMPL1111101 L1/S OF CILIFOR1l1. CONPLIff DRIIIIG ON 11TICHED PLOT PLI1 SHEET. <br /> CALL •ALL NECE. SARY INSPECTIONS AT LE T 98 HOURS IN ADVANCE <br /> SIGNED X lW1X TITLE: DATE: <br /> ACCEPTED BY TIT•LE: DATE: /n7ro20` t� 4' <br /> arMj-,41` +rn •y�. trial^. kICJCIafu" S°(^ 53Ji(L"�SlLSP1GyIyl�ttl�r"err .,Irw.r �>�u sr .,..., ry��-wprr�- - <br /> 1'r ��N�'1'r�U <br />