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! 0 <br /> UNDENGRUUND TANK l 1bUl E HAZELTUN AVE . , STOCKTON CA II <br /> CLOSURE OR ABANDONMENT Telephone ( 20q ) 468- 34148 <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT RVIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOT: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT PHONE N _�((/ 372- 7263 <br /> C FACILITY NAME -PI <br /> ADDRESS _ <br /> -2.1. 710.. S. Mcr}8�ur Prr. l»acY� <br /> L OWNER <br /> 1r NQ..._ef D <br /> . ..ADDRESS ..h O. BOX . .71�00 r.Nelup t"8*4 ............. <br /> T it CROSS STREET I PHONE # / <br /> � <br /> C CONTRACTOR NAME r PHONE # / <br /> O I _._..W�STcR(J �1Elr� �U _I _... <br /> T I CONTRACTOR ADDRESS 27K5 Teepee, be. tie S*&) I CA LIC # lo �nqo <br /> R LIC CLASS ^ WORK . COMP . # ! INSURER <br /> A <br /> C FIRE DISTRICT PERMIT # <br /> T --- -- IRiY. ��URAI .. FIRE �5�rlcd <br /> R LABORATORY NAME SCS _--A64LAV(CRL L{8 PHONE N X13 <br /> SAMPLERS NAME l SAMPLING METHOD <br /> Iw I I . _--___ <br /> C VOLUME CHEMICALS STORED 1 DATES STORED CHEMICALS STORED <br /> II H ID # I CURRENTLY PREVIOUSLY <br /> E <br /> M w 55Q ernRicn To i (;A�Sduvi )es-e_.__.1. <br /> II _ TO <br /> C I TO <br /> TT TO <br /> L LIS ANY EXTRA TANKS ON A SEPERATF., SHEET <br /> p-_- ��I �I � Iwwwl�warw �w wlw NJ wwllwmwww �w� wl �wIwwwwllwlwwl�l <br /> jiL (SEE ATTACHMENT WITH CONDITIONS ) <br /> A PLAN REVIEWERS NAMEIAtmr— FAV ILA DATE 9- 14—�K <br /> N <br /> -- �'�ii�""�I�I��wwwwwN!�iwlwwwl�wlP�ww�" '��I���Ilwwwoq"�4�wwwNPJIE��"�"Iwwwwx�uww�'�ww�wwn�VJw��d9�ww�ull9ww'wwEiwiiiial�"�'i�ww6''�wl��Nl��iiG�ili��N��'�iiwib'�1wwGYJ ��wiw�i���wwiwitii&��Iwl �"� N <br /> APPLICANT MUST PERFORM ALL FORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAPS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGYITURE CERTIFIES TNR FOLLOWING: 11 CERTIFY THAT <br /> IN THE PERFORMANCE OF THE FORK POR YRICH THIS PERMIT IS ISSUED, I STALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOME <br /> SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT <br /> TO YORKMAN'S COMPENSATION LAYS OF CALIFORNIA. COMPLETE DRAWING 01 ATTACBRD PLOT PLAN SHEET, <br /> CALL FORA NECESSARY INSPECTIONS AT LEAST 78 HOURS IN ADVANCE <br /> SIGNED X `" TITLE: DATE: 1Z � <br /> 17 <br /> ACCEPTED p p TITLE: _ DATE : <br /> ISI q wlll� wtl '� n �I <br /> al", <br /> m,�ry pl�� .. w N Ilfl it 'lh a VI iil III ip � II <br /> I � �I � � Luwwl�wwdiwi� wl �w�w <br /> Is gNINVVVVtlWgYVNICINgVqVRDVIY�D�IWqqHVIWIqqVVNBVIIVGIVsALVgViWVVTfdDYWNqVZVBqqEIWVVgqWVNqVYVDVqWVNqNNVVANVCBgIDNO9VNY gVVVVYgVVNIWYVTdbVJ NVVgI1gVNVIVIYqVYqVVV�OMVNIq <br /> IFIINIOIINMIWIAIMAIO%�NIIIIIIAINtlPPoIqIOflIIWIdIIIIIMIMtlXliliiX�IIIIMIpAIIIIIH4111:IIIAlII11XWdIXNINXpXMIIItlIAIINNtlX10.�kpIgPWlll1&IIIIIAIIIIdIIIN0A10.'IIAIIIinuAIIIIgIIININIVPINqP1Y(IRIIIIAaI'tlNWlq@iI1Kf11tlllilli'NaYerypApINMIIIIIItlItlnNIIIIIIINnIIItl4i'tliAPpilllgl°gXiIIL1AAlYlA011NNIIN <br />