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SAtv'JOAQUIN COUNTY PUBLIC HEALTFrSERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PERMIT FOR PERMANENT(fEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br /> STORAGE TANK(S)EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE: <br /> 11 REMOVAL ❑ TEMPORARY CLOSURE M CLOSURE'IN PLACE <br /> FACILITY INFORMATION <br /> EPA SITE# PROJECTCONTACTEd StOCktOn PHONE# 467-3838 <br /> FACILITY NAME POSDEF Power Company. L.P. PHONE# <br /> ADDRESS 2526 W. Washington Street Stockton CA <br /> CROSS STREET Road 23 <br /> OWNER OPERATOR PHONE# <br /> CONTRACTOR INFORMATION <br /> CONTRACTOR NAME See Attachment PHONE# <br /> CONTRACTOR ADDRESS CA LIC# CLASS <br /> INSURER WORKER COMP` ` <br /> FIRE DISTRICT City of StorkronPERMIT# <br /> LABORATORY NAME K Primp, T,c PHONE* _ <br /> 7974 <br /> SAMPLING FIRM nr- PHONE # (650) 292-9100 <br /> TANK INFORMATION <br /> TANK 10# TANK SIZE TANK CONTENTS PRESENT 8 PAST DATE INSTALLED <br /> 39- TA253501 1,000 gal Used motor and machine oils 11/11/87 <br /> 39- <br /> 39- <br /> 39- <br /> 139- <br /> L39- <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS,FEDERAL LAWS,AND RULES AND <br /> REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING' -1 <br /> CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS <br /> TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTORS HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF TA WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKER'S COMPENSATION LAWS OF CALIFORNIA.' <br /> APPLICANTS SIGNATURE TITLE k4J1NS <br /> DATE_.?� <br /> ❑ APPROVED 9 APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br /> —�_ (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> PLAN REVIEWER'S N DATES $ O <br /> ANY DEVIATIONS FROM THIS APPLICAT N MU E SUBMITTED TO EHD FOR APPROVAL PRIOR TO COMMENCING WORK. <br /> CONDITIONS: <br /> EH 23 046(REVISED 08/13/99) Page 3 <br />