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4i1nPP�Licl-1109 POR PERMIT y: SAN JOAQUIN LOCAL HEALTH DiSTU :T `: <br /> UND[*UgD TANK t: I601 E HAIBLTON AWB. S 1160 CA <br /> CLOSURh uR ABANDONMENT Telephone (109) I68 t <br /> t 4141 ttR 4141 R:R" t :RL tt'tk tk:R:t'L R:tl:1;1 R R:ff tt:R R:R.:tl:R:R:R:R R tk <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDOHMEHT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT 81PIRES 96 DAYS FROM THE APPROVAL DATE. DO NOT YR1T8 IN ANI SIIADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> ----------------__== 81 l.l. (vlAc R•1 W o-N <br /> l EPA SITE i -- — PROJECT CONTACT 6 TELEPHONE <br /> CAI. 000 OOq 858--__L! --- <br /> F FACILITY NAME A(LGD FAGIL-("i`� 20-7(0 ----- PHONE 8 �2Oq� 33� 3�7g <br /> C ADDRESS x,00 EASr V-ETTLEMAQ LP4Ja <br /> LL::� -- <br /> TREET H(GH W P,'Y <br /> I PHONE I e-10 13{tRG�}P�uSeN ENG -S• <br /> T OWNER/OPERATOR <br /> Y ATL-PAIJTIC. I?IG(- RELD COMPANY (al&) 345- 309-7 <br /> C CONTRACTOR NAME F:1LLti1 CL GpNs'r2JG - -- PHONE 6 _a1G13 - <br /> O — i40 Gs�,� Po 2 T 8 t.u n LASS <br /> N CONTRACTOR ADDRESS 4CA LIC C <br /> LJ f;s7 -- <br /> 4YORK,COHP.0 <br /> R INSURER <br /> Lo D 1 1 ��?� 7rt�N�----- ---------- <br /> C FIRE DISTRICT wnt LF tp S�2 r E7 PERMIT 1/[NSPTR —�— <br /> 0 LABORATORY NINE AffLI ra ANd L7Ti-& 15Q01 uM. (.40-SPHONE I V(o - +57- - 713Co <br /> R --- — -- 7PH-503o c.ir DottS L.0 Fri "r`r.: ✓, << �� <br /> SAMPLING FIRM' Ap�111lUIN S S S - SIMPLING METNODDETX_S020_ eD� pops .A� 1$03) <br /> TNI{Y.JWUIIIBIINU!WNUINpUUI4UIIIIIUNIYINNIBUNNC,B1 <br /> i TANK ID I s. TANK SIZE ( CHEMICALS STORED CURRENTLY CHEMICILS STORED PREV[OUSL <br /> T II 1 o00 GA!- U)JL AQeD GA5o�INt- <br /> ---S w— ---- <br /> I -_139=Q..t_ ----- ------�—.---- -- — ----- - <br /> --�000 GAL .. U►J�ERpED_— "�._. SAM,+✓ --__-_-- <br /> N 31--a4a -02 --- �SPkME <br /> K ^_ _� - —�O oo 6 A L. - ---- --- — <br /> 4,00a GAL _�E6uLAiZ Gll, tOAQf- —_�P !�G_ <br /> 6 000 CAI, 1u I.Atz « _ SAME <br /> LIST ADDITIONAL TANK INFORHITION AS NEEDED ON SEPARATE FORK <br /> ' +: � '�i'!' �+' �"'' ' ''��!""""""'�,i°''�'�" �"° ��!UIhIII!NNiCNI!IBIIIUIIU9!!•!.Iz•Iad9tuaUi!Cl'w'll2ii;l!II!!UTI!J!1111UCGIUU1INiIIINIIILtiIUllII;NNUINIIN!IIIIWGIRNiiNIU'.iIiNINlY9117i11u'lll;a <br /> P ,��NIIIIUGOINIIIIIUk1UB9,IIIIIIIflIIWiIIINCIINUIUUIIIIUNNi6WNIlatiLA�!1611,1..8 �l.la.Ball„IhN,ULIiIII6111V�Jlu�.�i,�LIL�Ii.LLIw.,,.,IdIL�,wlll.f --- , <br /> 9 APPROVED — IPPROVBD WI1H COSDITI09S DISAPPROVED <br /> I�I'1 <br /> 1 L (SEE ATTACHMENT PITH CONDITiOYS) Nlm <br /> 7 G -------''' <br /> A PLIH REVIEWERS NAME _ __ ----_-_----- ----� ---- <br /> N / <br /> UV�IIIDD!U{�1lUNNUJH!RWW "'' UUGUN!NUIY'�II�UIINBUUBIINR''!'!U;�WBRUl1gUR! '1Nk�U!WINUiNfNiLh'UUltc!NUNIRUUIINUUUIItlI.NIUN!UUIIPP�Il11DfI1NIUB'J�iNIBfUWWUU+!N!!II[iilUNl6'66gUBWBRWf4RIUIJNJI!IN9UYNINBNl�41,tiIBi1�!IRIU!JIRNli�N!I <br /> APPLICANT MUS? PERFORM ILL YORK IM ACCORDINCE WITH SAN JOIQUIH COUNTY ORDINANCES, STATE LIVS, AND RULES IND REGULITIONS <br /> OF THS SIN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICEYSED AGENT'S SICNITURS CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE YORK FOR YHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH HINNER AS TO BECOX). <br /> SUBJECT TO YORKER'S COMPENSIT[ON LAYS OF CILIFORNIA.' COMTRIC?OR'S HIRING CR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN 419E PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC, <br /> w TO YORRKKBF.'S_- MPE@SATIOH LAYS OF CALIFORNIk. <br /> k clrLLn�—�7 <br /> ECTIONS AT LEAST 4B IIOURS IN ADVANCE <br /> ----- ----- --DATE_-- ZS�`1 ------- <br /> - <br /> OFFICE US OHL'l--8J 016 1215 <br /> M$$$$$$$$$$$$�SS$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$:$$$S$$$$`r$$S$$$$$$$$$$$$$$$a:$$$$$$$$SiS$$$$$$$$$$$$$$$$$$$i$$$$$$$S$$$$$$ <br /> SYBFrS I COMP I ( LOC CODE I DIST CODE' IMOUNT DUE AMOUNT RCVD I CK1/CASlf I RC90 BY DATE RCVD PERMIT I <br /> -- ................. <br />