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t=t tl tt t ;t3 t;it,t1rtvtvit:tyn:rr�tvt3.atnratr-t:.tytt:&:it'ti,it. <br /> IPPLICITIOM FOR PERMIT $AY JO1 UIII LO <br /> t. Q CAL @E1L1H DISTRICT r: <br /> t: UNDBRCROUYD ?ANI t: 1101 E WELTON AVE., STOCKTON Clt: <br /> t: CLOSURE OR 1DINDOIA911 t: Telephone (2091 168-3120 t: <br /> t:itt1:11 ti:ti:t141:11:11:ttt-it:t111:fftra:an:n:aatni:tic.tva.aamtnra. <br /> APPLICATION FOR PBRMINBMT/19MPORIRT CLOSURE OR ABAIDOHN£NT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES SToRICE FICILITT <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE 1PPROVIL DATE. DO NOT 111TS IM 111 SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> X <br /> REMOVAL TEMPORARY CLOSURE _ AHWOOMMEN1 IN PLIC: <br /> EPA SITE I PROJECT CONTICT i TELEPHONE 1W- A' POng, E es <br /> ( 916) 444-9378 <br /> P FACILITY NINE Graphic Contractors PHONE 1 (209) 465-3380 <br /> 1 —.�- <br /> C -DRES� 1325 West Weber Ave. , Stockton, CA <br /> L CROSS STREET Washington <br /> I ' <br /> T OYNERIOPBRITOR P@OVE 1 ( 415) 974-4544 <br /> T Catellus Development Corporation <br /> C CONTRICTOR 11M1 Jim Dobbas, Inc. PHONE I (916) 663-3363 -- <br /> 0 <br /> Y CONTRI]Alexander <br /> IDDRESS P.O. Box 177, Cl LIC 479128 CLASS `a' <br /> T Newcastle CA Addendum <br /> R INSURER & Alexander En arcadero St. , San Francisco YORX.COMP.1 W1100302 <br /> A _ <br /> C FIRE DISTRICT Stockton City Fire Dist_ PERMIT 1/11SPTR <br /> 0 LIBORIfORY NINE Curtis & Tompkins, Ltd. PHONE 1 (415) 486-0900 <br /> R <br /> SIMPLING FIRM2 ERM-West, Inc. SIMPLING METROD By hand/Brass tube <br /> ��uauuunuuruiNwu�euu�:w nwxr o.�i..�:Mi9R! ' <br /> TINX ID I TAXI SIZE CHEHICILS STORED CURRENTL CHEMICALS STORED PRIVIOUSL <br /> T <br /> 1 39- 500 gal. gasoline or <br /> I 39- <br /> Z9- <br /> 39- <br /> LIST IDDITIOVIL 'INK INFORHITION IS NEEDED Of SEPARITE FORM <br /> tIIIN81lRItIUkIRR11JIIRNEY�IfGY Illi RyDRIltl1UiUCllR4iIIN{WWIC{I I!i.GDtll911'�IINIIGIruilll�ltll�"1C� ll�l�il11U l��III�1tL1rWIDlLYtlll!'�ll �� JLI7�L'liRDl IIIUV�I WI ' ' 411 MELWfWiR1U <br /> APPROVED APPROVED WITH CONDITIONSDISAPPROVED <br /> 1 PLAN 169[EWERS NAME <br /> (SEE 1TTICHMEMT WITH COYDITICWSI� <br /> � DATE <br /> APPLICANT MUST PERFORM ALL WORT( IN ACCORDANCE WITH SIN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SIN JOIOUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SICYITURE CERTIFIES fNE FOLLOWING: 'I CERTIFY THIT <br /> IN THE PERFORMINCS of THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY IVY PERSON IN SUCH MIVMER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSITIOM LIPS OF CILIFORVIL' CONTRACTOR'S HIRING OR SUECOVTRACTIVG SICNATURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY ?HIT IN THE PERFORMANCE OF THE WORT FOR WHICH THIS PERMIT IS ISSUED, I SHILL EMPLOY PERSONS SUBJEC <br /> TO WORXER'S COMPENSATION LAWS OF CILIFORVII. <br /> CALL FOR INSPECTIONS AT LEAST 40 EIOURS IN ADVANCE <br /> SIGNED DATE <br /> OFFICE USE ONLY--911 23 Ulf 12/11 - <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSaSSSSSSSSSSSSSSSSSSSSSSSSS€SSSSSSSSSSS€SSSSSSSSSSSS€SS€SSSSSSS€SSS <br /> SWEEPS I COMP I LOC CODEDIST CODE 1NOUN7 DUETI AMOUNT RCVD CXI/CIS@ RCYD BY O1TI KCVO PERMIT <br />