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ENVIRONMENTAL HEALTH DIVISION <br /> APPLICAiIOH TOR UNDERGROUND TANK CLOSURE PERMIT <br /> FACILITY <br /> APPLICATION FOR PERMANENT/1 <br /> EHPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND <br /> AHAZARDINDICUBSTANCEATE ST1rPEEBELOW: <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY <br /> �(— E ABANDONMENT IN PLACE <br /> REMOVAL TEMPORARY CLOS UR <br /> (209)9 y <br /> PROJECT CONTACT R TELEPHONE N LO <br /> ' EP 1 PHONE N _ <br /> F FACILITY NAME Lowell Rathe Mobil 11ome sales <br /> A <br /> C ADDRESS 2101 E. Charter Way <br /> i <br /> -' ( CROSS STREET PHONE N <br /> 1 Same as above <br /> 1 oW11ER/OPERATOR Same as above <br /> -• Y PHONE N <br /> _ 20 68-b115 <br /> rpe U <br /> C CONTRACTOR NAME Jim '1'hn _ it IIIc. / U.U.A. Rech-P1art Cunst. cuss <br /> DT"j�[leckmall R l CA LIC N/ r ( A U Ilaz. <br /> .. N CONTRACTOR ADDRESS po ilx. 351 LU(1i (al. y��Zfl1-03� <br /> WORK-COMP-1 1()9`31.-1 j-90 <br /> 1 <br /> R INSURER 1'11'('.111:1I 1:i AdIII11' 1 Fire permit will be <br /> A <br /> w PERMI T N p_L1{�SLJr�-aIJP "� <br /> C FIRE DISTRICT City of Stockton <br /> PHOiIE N <br /> i <br /> O LABORAIORY NAME GeoAnalytical Laboratories <br /> PHONE N Same as above <br /> R <br /> SAMPLING FIRM Same as above <br /> — 1111111111111111111111111111111 TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE Us? INSTALLED <br /> TANK 10 N 12 000 gal. Regul r Gam ine <br /> 39 -?sig <br /> A 39 <br /> N 39 <br /> K <br /> 39 fj It'�I�I'�t'�'t't'ttttt�t �t'tt I t�tf <br /> - ttttittititttitititititttititt it fii�itititiniiint <br /> P DISAPPROVED <br /> APPROVED APPROVED WITH CONDIiIOH(S) <br /> I (SEE ATTACHMENT WITH CONDITIONS) <br /> ------------ -_— DATE <br /> A <br /> _��LIIIIIII�IIIIIIIII <br /> N PLAN REVIEWERS NAME <br /> ...� I'I't�"tltlt'tlltt ttt�t"t�'It'Itltltl�ll�l'I�t'�I'Itl�t"tttittf""'�'t"t'� <br /> — ttttt��'t'tttt"t't��'t <br /> T IN <br /> WITH SAH JOAoU1N COUNTY ORDINANCES, SiAIE TANS, <br /> NATURE CERTIFIES THE FOLLOWINGS "1 CERTIFYAND RULES AND REGULATIONS O <br /> APi'(ICAN1 MUST PERFORM ALL WORK IN ACCORDANCE <br /> r SAN JOAOUiN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICE THE <br /> THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON LICENSED AGENT'S SIGRE CERTIFIES THE FOLLOWING: <br /> 111E PERFORMANCE Of iNE WORK FOR WHICH NG OR SUBCOHIRACIING SIGNATU <br /> CIN SUCH A MANNER AS TO WORKER'S <br /> SUBJEC/ 10 WORKER'S COMPENSATION LAWS OF CALIFORNIA-11 CONTRACTOR'S HIRIi SHALL EMPLOY PERSONS SUBJEC <br /> ..� ,I CERTIFY THAT IN THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED, <br /> COMPENSAiION LAWS OF CALIfORN U^,!) <br /> Tim ,•�1L1_�IS��QL---= DATE <br /> APPLICANT'S SIGNATURE: <br /> Page 3 <br /> EH 13 OG6 (Rev 2/8/91) ft <br />