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ENVIRCNMENTAL HEALTH DIVISION 1 Ct y <br /> APPLICATION FOR UNDERGRCUND TANK CLOTURE PERMIT ENVIRONMEN'I'ALHEALTH <br /> PERMIT/SERVICES <br /> APPLICATICN FCR PERMANENT/TE1HPCRARY CLOSURE OR A3ANDCNMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FRCH THE APPROVAL DATE. DO NOT GRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE 3ELCW: <br /> X REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> 'aA S!T E $ CAD-980886873 PROJECT CONTACT & TELEPHONE R MIKE HARB I CK 209) 263-5217 <br /> F FACILITY NAME PACIFIC GAS & ELECTRIC 209) 263-5217 <br /> A <br /> C ADDRESS 4040 West Lane Stockton, CA <br /> I <br /> L CROSS STREET Burbon <br /> YLt <br /> ° r OWNER/OPERATOR Pacific Gas & Electric P"C"E " <br /> 209 ) 263-5217 <br /> CCNTRACwCR NAME FRANZEN HILL CORPORATION dba FHEMCO PHONE 1 <br /> 209 688-2977 <br /> 0 <br /> N CONTRACTOR ADDRESS 1100 North d Street r CA LIC x $17079 CUSS A & B <br /> T <br /> R 114SURER Zurich—American Insurance Group WORK. <br /> A P 1 179-7515-2 <br /> C =IRE DISTRICT receive I a'Z+stT <br /> We have met w/ Fire Dept . , will <br /> T <br /> D LAcORATORYNAM'c TWINING LABORATORIES PHONE » 2 0 9) 2 6 8-7 0 2 1 <br /> IR <br /> SAMPLING FIRM TWINING LABORATORIES PHONE 2 0 9) 2 68-7 0 2 1 <br /> 11II]II11I111I1111111I111II]I1 <br /> TANK :0 T TANK SILO CHEMICALS STORED CU'RRENTL'.'/PREVICUSLY I DATE UST :NS7AL!ED <br /> 39- II <br /> 39 �, , _Lq-� " <br /> A 39- No 2 3 7-1 d e d <br /> 1971 <br /> N 39- No . 3L3'7-- - 1-- ed 1971 <br /> > 39-W No . 4 3q-/!F/op 5 Q 0 0 Diesel 1971 <br /> 39- <br /> 39- <br /> P II1111I1111I11i1I1IIIlIIIIIIII I11I1I]II1I111111III11111111111I�II1fI1I1111III111111II1I11I1I111I]I1I]IlIIII1iIII1I1I11I���II <br /> L APPROVED APPROVED WITH CONDITICH(S) DISAPPROVED <br /> (SEE ATTACHMENT WITH CONDITICNS) <br /> H <br /> PLAN REVIEWERS NAME DATE <br /> 11111111111111111 11111111 II 111111111111111111111111111]I 111 II 11111111 II 111 II II III II 1111111111111111111111111 I]I I I�I 1 I I11I I <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JCACUIN COUNTY CRD:NANG`S, STATE LAWS, AND RULES AND RCGULATiCNS OF <br /> SAN JCACUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICcHSED AGE'NT'S SIGNATURE CERTIFIES THE FOLLCWING: "I CERTIFY THAT IN <br /> THE PERFCRN.ANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO 3ECCME <br /> SUBJECT TO ;4RKER"S CCMPCXSATICN LAWS OF CALIFORNIA." CTCR'S HIRING OR SUBCONTRACTING SIGNATURE C=RTIFI=S THE FOLLCWING:. <br /> "I r"RTIFY THAT IN THE PERFORMANCE OF THE WORK FOR W CH IS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT 70 '-'CRK=.R'S <br /> CC �ATICN LAWS OF CALIFORNIA." <br /> APPLICANT'S SIGNATURE: rITL= CEO DAT= 9 / 11 /91 <br /> Bob J . Hill <br /> 23 046 (Rev 2/8/91) `t Pace 3 <br />