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11116%98 17:23 <br /> ..__- _•_ _ NO.108 1?03 <br /> • <br /> SAN JOAQUIN COUNTY PUBLIC HEAL'T'H SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THE PERMIT FOR PERMANENTITEMPORANT CLOSURE O ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br /> EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> X REMOVAL TFMPONANT CLOSURE _ CLOSURE IN PLACE <br /> .. EPA SITE P CAC 0 to 17.144 1)H I I PROJECT CONTACT b TELEPHONE P TEX STORLEY 209-832-5012 <br /> F FACILITY NAME JAMAR SERVICE P"O"E B <br /> A <br /> C ADDRESS 4075 E. MAIN STOCXTON <br /> I <br /> L CROSS STREET ORO <br /> PHONE IF <br /> T OWNER/ ERATOA JAY Mc ILRATH 209-462-8707 <br /> T <br /> C CONTRACTOR NAME CONSTRUCTION P"O"E 0209-832-5012 <br /> H CONTRACTOR AAEssP.O. SOX 1008 TRACY CA Ca LIC B 492743 CLASS A6B8HA7 <br /> DD <br /> T <br /> R INSURER PROMPT FINANCE INC. HOAR-COMP's 000091-97 <br /> A C PERMIT P <br /> C FIRE DISTRICT S Yodc QAt .z I, <br /> PHONE 1 ` <br /> 0 LABORATORY NAME C COUNTY Q— O _ <br /> A <br /> SAMPLING FIRM - "ONE R ZO — OST 6 <br /> 11111111111111{111t1111111l111 1 OTANK =512E I CHEMICALS TONED CORREMTLT/PREVIOUSL7 DATE u5 <br /> TrX 10MS7 LLED <br /> 39• L. M W <br /> i 39- <br /> A 39• <br /> N 39- <br /> 0 39- <br /> 39- �EE�TEE�� <br /> 111) IIFrtIRIFRFAFR+� <br /> L ! APIPRCVED APPROVED WITH TX CONDI ROM<S) <br /> DISAPPROVED <br /> A IEEE CONDITIONS BELOW AND/OR ON ATTAC T) <br /> PLAN REVIEWER'S NAME DATE <br /> 111111lI{111{1111{{1111111111111111111{11{{11111{11!1!!1 11 1{111{1111111111111{{{1111111111111111{{{11111{!1{1111111111111 <br /> APPLICANT MUST PERFORM ALL YORK IN ACCORDANCE WITH SAN JOADUIN COMITY malMANCES, STATE LAWS, AND RULES AND REGULATIONS Of <br /> SAN JOAQUIN COUNTY PUBLIC WEALTH SERVICES. OWNER OR LICENSEDAGEMLLSMOTpNATUREMPLOY ARTYIPIES►FRSORTIM <br /> N FOLLOCH WINNG ! -1 ACERTIFY <br /> S TO FECOHTHAT <br /> IN <br /> NN <br /> THE PERFORICE Of TME WORK FOR WNICN THIS PERMIT IS ISSUED, I H <br /> SJECT TO ONIXER'S COMPENATION LAWS Of <br /> LIFORNIA." CaNylLACTUR,S <br /> at <br /> ING <br /> '"IIBCERTIFY YTHAAT 11 TNE PERFOF THEUWORK FOR WHICH THIS PERMIT 191155I1E0�l�SHALL TEMPLOTSIGNATURE <br /> ►ERSOMS SUBJECTCERTIFIES <br /> TOTHE <br /> WOKER'SI�IN' <br /> COMPENSATION LAWS OF CALIFORNIA." n <br /> APPLICANT'S SIGNATURE: TITLE ®Ld�e�J� DATE 7 <br /> CONDITION(S): <br /> NOV 16 1998 <br /> ENVIRONMENTAL HEALTH <br /> EM 23 046 (Revised 9/11/96) Page 3 PERMIT/SERVICES <br />