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11i1b'98 17:2 <br /> N0. 108 907 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERWT <br /> THE CE <br /> EMPIRES"90 DAYS FROM THE/APPROVALTDATEE,CLOSURE00 MOTEfRITTEINTIN AMY SHADED AREAS.CE OF GROUND INDICATHAZARDOUS <br /> PERM TYPESBELOY:STptAGE TANK <br /> NOMAL TEMPORARY CLOSURE _— CLOSURE IN PLACE <br /> PROJECT CONTACT d TELEPNONE 9 TEX STOKLEY 209-832-5012 <br /> EPA SITE a C4G O JO 1-4144 m1 <br /> F FACILITY NAME JA14AR SERVICE PHONE e <br /> A <br /> [ ADDRESS 4075 E. MAIN STOCXTON <br /> 1 <br /> L CROSS STREET ORO <br /> T OWNER/OPERATDA JAY Mc ILRATH P"REB 209-462-8707 <br /> f <br /> PHONE '►209-832-501 2 <br /> C CONTRACTOR NAME $ UC ION <br /> D CLASS A&BBHAZ <br /> N CONTRACTOR AODRESSP.O. BOX 1008 TRACY CA CA uc R 492743 <br /> T YORK.Ca►.N 00 0 0 91-07 <br /> R ENSURER PROMPT FINANCE INC. <br /> A FZ PERMIT M <br /> C FIRE DISTRICT .s Y Q <br /> T PHONE B p- <br /> 0 LAEONATORT MAKE COUNTY _ <br /> A MIRE R —w 0 _ oe 6 <br /> SAMPLING FIRM - -- . <br /> 11111111t111t11l11�1111111ltl1 TANK SIZE CHEMICALS ;TORED CURREITLT/PREVIOUSLT DATE US NST LLED <br /> T AK ID 6� <br /> 39- ( DOD <br /> T 39- U <br /> A 39- <br /> N 39- <br /> K 19- <br /> 19' ffaufffffuum <br /> 1111ffmffmuffmm <br /> P <br /> AMROYFD RPPROVEO WITH CR0IIIR(S) DISAPPROVED <br /> L (SEE COMDINONS BELOW AND/OR ON ATTRC I( N11 <br /> A <br /> N DATE <br /> PLAN REVIEWER'S NAME <br /> illltllilllllllllitlltlllllllllllllllllllltlitlllillllll 11 111111IIIIIIItllill111111111111111111111111111111111111111111It <br /> APPLICANT MUST PERFORM ALL WORK 11 ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,ESTIFIES THE STATE LAWS, AND RULES AMD RCERTIFY THAT OF <br /> SAN THE VON�IDRMANCEROF PjgtjC <br /> iR WMLTH HIICH THIS PERRPIT /S ISSUEDE0 IA$HALLSHOTRATuft <br /> ENP OY ANY PERSON M SUCH AAI FOLLOWING: 'I <br /> ASToBEcmEIM <br /> SUBJECT <br /> CcRTIFY THAT Ill RFORIFLANCE OF ATION LAWS THECAWRK FOR WHICH H TM 9 PERMITA 19 ISSUED, IOR �SNATLLCTERPLOT PERSONS SUBJECT To CERTIFIES <br /> TOTHE <br /> WORKER'S <br /> CRPEMSATION LAWS OF CALIFORNIA." <br /> ZZ <br /> APPLICANT'S S(ONATIJRE: <br /> TITLE _ ®Ld.V DATE 9 <br /> CONDMON(S): <br /> 40 441 <br /> NOV 16 1998 <br /> ENVIRONMENTAL HEALTH <br /> EN 23 046 (Rwieea 9/11/96) PADe 3 PERMIT/SERVICES <br />