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A t't tt:t to L L.a t t:Ltp n:Lt tt,U:L 1:ff tt:R:tt:t ts t L:*11 t t:U: <br /> AlQUIA AUC'J, AEA'Ll:1 ^1�1 if C7 <br /> UNDERGROUND TANK 1601 9 AAZELTON AVE., STOCXTOJ 011, <br /> CLOSURR OR ARANOnWARIT faianhnna I Inq I I q j n <br /> IPPLICITION FOR P9RMAH91T/?EMPO1IRY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HIZIRDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO MGT 111?8 19 111 SHADED AREAS, INDICATE PERMIT TYPE BELOW: <br /> REMOVAL TEMPORARY CLOSURE ^ ABANDONMENT IN PLACE <br /> EPA SITE I CACY 0)1 n9589 PROJECT CONTACT 4 TELEPHONE I Hack (209 ) 466-3831 <br /> ..........— ( - <br /> F FACILITY NAME D . A . Parrish & Sons , Inc . P 9 F 1 w lc�i <br /> I <br /> C ADDRESS 2905 E . Miner Avenue <br /> I <br /> L CROSS Stilly Shasta Street <br /> I -- L-1\1�M <br /> I OWNER/OPERITOR PROVE I PERMtT I SERVICES <br /> Miles A. Parrish ( 209 ) 466-3831 <br /> C CONTRACTOR MINE Parrish, Inc . PROVE 1 (209) 466-3831 <br /> O <br /> I CON?RICTOR ADDRESS 4000 N. Wilson Way CA LIC 1 100511 CLISS A <br /> 7 TC <br /> R INSURER Angelo hawkiiis 3D-11'1S WORLCOMP.1 <br /> State Comp 1095683-88 <br /> C FIRE DISTRICT City of Stockton PERMIT I/INSPTR Not available <br /> 7 <br /> 0 LABORATORY NAME Canonie Environmental PHONE 1 (209) 948-1345 <br /> R —7- <br /> SAMPLING FIRM' noni� 17 ironmental SAMPLING METIOD_Cr ":":5 <br /> �obam,�pe- ln �rass tMe <br /> 0.7, t)nckhoe.2ft. under tank <br /> TING ID ITINA S119 CHEMICILS STORED CURRENTL CHEMICALS STORED PRIVIOUSLI <br /> QL. 10000 Regular Gas <br /> LIST IDDITIONIL TANK INFORMITjoy IS NEEDED ON S2phRITR poll <br /> APPROVED _APPROVED WITH CONDITIONS 019APPROYID <br /> L ITTACHKENT WITH CONDITIONS) <br /> I PLAN REVIEWERS NINE DATE <br /> APPLICANT MUST PER FORM ILL WORK 11 ACCORDANCE 1170 SIX JOAQUIN COUNTY ORDINANCES, STITZ LAYS, IND RULES IND REGULATIONS <br /> OF THE SIN JOAOUIN LOCAL HEALTH DISTRICT, OWNER OR LICENSED AGENT'S SIGMITURS CERTIFIES THE FOLLOWING: 11 CRRyIFy THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, <br /> I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS To BECON, <br /> SUBJECT TO YORKER'S COMPEISITION LAWS OF CALIFORNIA.' CONTRIefOR'S HIRING OR SUBCOMT94CT[IC SIGNATURE CERTIFIES THE <br /> FOLLOWING: 11 CERTIFY ?HIT IN THE pEjF0jXjVCj OF THE YORK FOR WHICH THIS PERMIT 13 ISSUED, I SHALL EMPLOY PERSONS Suaijej <br /> TO WORKER'S COMPENSATION LIVS OF CILIFOR]I[I. <br /> CALL FOR INSPECTION LEAST 48 HOURS IN ADVANCE <br /> SIGNED <br /> Y 2 DATE <br /> 17L <br /> OFFIC U I ONLY--EH 221 041 12111 <br /> SWEEPS I COMP I OC CODE DIST COORI AMOUNT DUE AMOUNT RCVD ell/CASs RCVD BY DITR RCVD PERMIT I <br /> 11�5 L <br /> ex je= ft-1 51 <br />