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' ttxtxtxtxttl'!"fxr.•txt tr•txex�txtx�txrttt�tttxtxtt�txartxtztxleKftxtxtx <br /> �• APPLICIf10N FOS PES It SIN JOIOUII LOCAL HEALTH DIStfICTk. WHIM <br /> t: UIDBRGROUND AN t: 1601 B HAISLTOM A96., STOCKt01 CIt: �A IItIIIJJJ' <br /> t CLOSURR OR IIIA N If r Telephone (2091 468-3426 t <br /> tit:it:txit:ti:it:RR!tt.ttxartxR:txtxRtztrtx.t txRR:txRRRit:txtrtyR MAY 1 <br /> 1991 <br /> APPLICATION FOR PERMANENT/16MPOIIRT CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND RIIIIDOUS SUBSIINCBS ST0210E FICII,ITY <br /> THIS PERMIT RINSES 90 DAYS FROM THE APPROVAL DATA. DO NOT 11116 IN 111 SIIADE) AREAS. INCH l Erl62Q)iRWim AESjk� <br /> ✓RENOTAL TEMPORARY CLOSURE 19110ORMENT IN PLACE <br /> EPA SITE I PROJECT CONtICT A TELEPHONE <br /> (Zicx `y—�10L-a <br /> IV - Oo:i <br /> F FACILITY NAME SlleI,LSe6z:�t-G STjh ipL.l PRONE 1 (22 ) 411 - 1103 <br /> A <br /> C IDDRESS3011 W. 650_4AJII1J I{oIT LV, iS <br /> 1 <br /> L CROSS St1EIf TiJ1>;esr�7 S <br /> I <br /> I OVNIR/OPERItOR PHONE 1 <br /> Y ISI kDwcK (zssc)) 411- 1703 <br /> C 'CONTRACTOR NIMB . �Ya� PHONE 1 (AS) -183— lSUO ---- <br /> 0 <br /> I COVIRICTOR ADDRESS ICJ92 �/� rpt���� /tom b CI LIC I CLASS <br /> T — <br /> I INSURBI YORK.COMP.I <br /> C FIRE DISTRICT-ST rlZia DEPT PERMIT I/[NSP TR <br /> I <br /> 0 LABORATORY LIME C/,I.IL)ji G L_, ,T36 PHONE I (200j) 983" I Mb <br /> R <br /> SAMPLING PINK' /�E ISI E6I,/IROFI �TAL_ SAMPLING METHOD (4n-y6 l-jc-TNop <br /> TANK ID I ?III SITE CHEMICILS STORED CURRENTLY CHEMICALS STORED PRBVIOUSL <br /> f <br /> t 39- <br /> 1 39- <br /> 31- <br /> 9 39- 000 n I,N 5 E <br /> 39- - <br /> - LIST ADDITIONAL TAKE INFORMATION AS NEEDED Of SEPAR119 FORK <br /> EINIA�NORKOMININIItlGtINtOtl�OltD�pflNR6tlIt11M IPNIpNNMfpptN66616W8917YWItl7F7tlC�K�1tNN9IM!JI9C041tltENtlyOfYal'JtlMIN:117tRnIB6IYll�ltidA9l'ItM1MIM16�Ki1'BIWNNmR <br /> P APPROVED _IPPROVBD 11TH CONDITIONS _ DISAPPROVED <br /> L (SBR IITACRMtMT VI1H COKDITIOYSI <br /> A PLIN 117I6YERS NIMB <br /> I <br /> 1 <br /> IPPLICANT MUST PERFORM ILL YORK 11 ICCORDINCI VITA SIN JOAOUIN COUNTY ORDINANCES, Stilt LITS, AND RULES IND REGULATIONS <br /> OF TNV SIN JOAOUIN LOCAL HEALTH DISTRICT. 01111 OR LICENSED IGtNT'S SIGIITURB CERTIFIES THE FOLLOVING: 11 CERTIFY THAT <br /> IN THB PtRPOIMANCB OI THE WORK FOR YRICH THIS PERMIT 18 ISSUED, 1 SMALL 101 EMPLOY ANY PERSON IN SUCH MINTER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LATS OF CLLIFORIIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES INA <br /> FOLLOVIIG: 11 CtITIFY ?HIT IN THE PERFORMINCI OF THE YORI FOR VNICH THIS FIRMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJIC <br /> 10 YORKER'S COMPENSATION LITS OF CALIFORNIA. <br /> CALJ FOR INSPECTIONS AT LEAST 40 FOURS IN ADVANCE <br /> SIGNED_ �� LSS 0 � �� -- <br /> OFFICE US --ONLYN 23 016SS /11 �J ��I o yl/6 <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS °SSSS SSSSSSSSS SSSS SSSSSSSS fSfSSSSSSSSSSSSSSSSSSSSSi <br /> STEEPS I COMP I LOC CODE DISt Ct -1 AMOUNT DUET AMOUNT RCPD CKI/CASA I "VD BY I DAYS RCVD I PERMIT <br /> `"I <br />