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VA& ed <br /> I APPLICATION FOR PERI SAN JOAQUIN A��ALTH ;rc <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone ( 209 ) 968-3420 <br /> IPPLICITION FOR PERMAMENT/TIMPORIIY CLOSURE OR 1911DONKIII IM PLICE Of UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EZPIRES 10 DAYS FROM 711 APPROVAL DATE. DO HOT WRITE II All SNIDER AREAS. IWDICITE PERMIT TYPE BELOW: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> 2LIL/- <br /> F PROJECT CONTACT M PHONE M <br /> A Lk)HLt �xp,LL_ C )"'s <br /> ---.. <br /> C FACILITY NAME — ADDRESS is <br /> I <br /> �Lw`E rail �l IL. LLL <br /> L CROSS STREETPHONE <br /> Ih1 L� f2 <br /> _SON —._ --- — <br /> T OWNER PHONE M <br /> Y ftLMK _ <br /> C CONTRACTOR NAME ��-h LL. co(V -t-PHONE M _ / G k A J 6 a �� <br /> 0 — --- — <br /> N CONTRACTOR ADDRESS 350 Uj CSR t(.D t�_A CA LIC N 2430 <br /> T <br /> R LIC CLASS WORK . COMP . 0 10 0 57o s w INSURER <br /> C FIRE DISTRICT C L)S PERMIT N <br /> T — — -- <br /> 0 LABORATORY NAME CRN D (FJ L PHONE M / <br /> SAMPLERS NAME SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID M CURRENTLY PREVIOUSLY <br /> M r,.1A 6--T 0 <br /> I TO <br /> C TO <br /> A TO <br /> L LIS ANY EXTRA TANKS ON A SEPERATE SH ET <br /> i <br /> PFK 1H C � <br /> L (SEE ATTACHMENT WI H NDITIO S) <br /> A PLAN REVIEWERS NAME REVIEWERS NAME%�r L�_��DATE <br /> N <br /> r =EMIR=Mi, i <br /> 1PPLICI11 MUST PERFORM ILL WORE IN ICCORD/MCI WITH $IH JOIOUIH COUNTY ORDIW►WCKS, ST/TE LAWS, AID RULES AND REGULATIONS <br /> OF THE SII JOIOUII LOCAL 1811.71 DISTRICT. OILER OR LICENSED LOUT'S SIGNITURE CERTIFIES THR FOLLOWING: 'I CERTIFY THIT <br /> IW fog PRRFORMAICE OF THE WORK FOR /HICK THIS PERMIT IS ISSUED, I SHILL NOT EMPLOY ANY PERSON 11 SUCH MIRNER IS TO BECOME <br /> SUBJECT TO IORKMII'S COMPEISATIOI LITS Of CILIFORMII., COITRICTOR'S HIRING OR SUI-CONUICTING SIGNATURE CERTIFIES THE <br /> FOLLOYIIG: 'I CERTIFY Tilt YN 7KE PERFORMANCE OF THE FORK FOR FRICH THIS PERMIT IS ISSUED, I SEILL EMPLOY PERSOIS SUBJECT <br /> TO F011911'S COMP11817I01 LAWS OF CILIFORNIA. COMPLETE BEIRUT DR IfTICHED PLOT PLII SHEET. <br /> CALOR ALL NECESSARY INSPECTIONS AT LEAST 98 HOURS IN ADVANCE <br /> SIGNED TITLE: DATE: <br /> DATE: <br /> ACCEPTED B -PLE:� DATE: <br /> ���' ABG SII 'Atl191iVMVHM�IDIHgMDD�PIE610Ik9�V01RIPYIIKINhIN0111DgNR91Hf116ER1161G" 1H�I '1'c'F1"��09WGDIB'1'�I�"�'JN"w1L00r�MI�IR I�11� '!9--- <br />