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11i16i98 17:23 <br /> • NO.108 j 13 p -1 <br /> l0 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES J_ <br /> , <br /> ENVIRONWNTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT a"� <br /> THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND ""ARMS SUBSTANCE ST RISE TANK <br /> EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELWv <br /> X REMOVAL TE14PONARY CLOSURE _ CLOSURE IM PLACE <br /> EPA SITE R C-AG ov/G 17,1 `q WIN PROJECT CONTACT B TELEPHONE N TEX STOKLEY 209-832-5012 <br /> F FACILITY NAME JAMAR SERVICE P1 • <br /> A <br /> t ADDRESS 9075 E. MAIN STOCKTON <br /> I <br /> L CROSS STREET ORO <br /> PHONE R <br /> T OWNER/OPERATOR JAY Mc ILRATH 209-462-8707 <br /> T <br /> C CONTRACTOR NAME PHONE 0209-832-5012 <br /> O S IO <br /> N CONTRACTOR ADORESSP.O. BOX 1008 TRACY CA CA LIC N 492743 CLASS A&BSHAZ <br /> T <br /> R INSURER PROMPT FINANCE INC. IMK.ONM.N 000091-97 <br /> A PERMIT N <br /> C FIRE DISTRICT 5TF.Id� Q z E <br /> T [ <br /> 0 LABORATORY NAME L CNNTY PHONE B 0- � - p <br /> R _ PHONE P ZO p _ Oe 6 <br /> SAMPLING FIRM - <br /> 1111111111111111111111111 :: <br /> T NR ID TANK 512E CHEMICALS ;TORED NRRE iTEF/PREVIOUSLT DATE u5 MST ILEO <br /> 39• - <br /> T 39- <br /> �. <br /> A <br /> 39- <br /> 39- <br /> K <br /> 9•39-K 39- <br /> 39- <br /> 39- <br /> L <br /> 9•39•39-L APPROVED � APPROVED WITH W AND/OR <br /> DISAPIROVEO <br /> A 9E COMDITIOM3 BELOW AND/OR ON A7TAC HENT) <br /> N i <br /> PLAN REVIEWER'S NAME DATE <br /> 1111111111111111111111111111111{1111111{I1{111111lIIIIiI II I{111!11{1111!1111{{111111111{{1{{{111111{11111{1111111{{{{1111 <br /> APPLICANT MUST PERFORM ALL YORK 19 ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING= "1 CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED. I SMALL HOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WONKER'S COWENSATOON LAWS OF CALIFORNIA." CONYRACTOR'S WIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWINt <br /> "I CERTIFY THAT IN THE PERFORMANCE OF TIRE WORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORNIA." n <br /> APPLICANT'S SIGNATURE: TITLE ®Ld.C/a;'fJ DATE 7 ✓ <br /> CONDMON(S): f - 3 _ <br /> EM u 046 tHwFNe3 �1/96�i <br /> PERMIT/SERVICESL D <br />