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j <br /> MAR 17 '39 09:54 FETROL ENGINEERING 7075457068 F'.4 <br /> APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DIStlICTI., <br /> UNDERGROUND ?AN[ 1601 8 HAZILTON AVII., STOCKTON CA <br /> Le. CLOSURE OR 111NDONNI8t Telephone (201) ill-3120 <br /> L1111,H,L1111: <br /> APPLICATION FOR PRRMkV1NT/TRMPOR11T CLOSURE 09 ABAIDOMMEKI IN PLACE OF UNDERGROUND NAZIRDOUS SUBSTINCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 50 D178 FROM T118 APPROVAL DI?9- DO NOT 111TE IN III S11AD11 AREAS. INDICATS PERMIT TIPS 11LOW, <br /> RlxoqAL TEMPORARY CLOSURE 101NDORMINT IN PLICII <br /> EPA fl?I I CAL 000003403 PROJECT CONTACT I TELEPHONE 1JOE COX 714-634-4800 <br /> F FACILITY MAKE "FAST GAS" 209-369-3124 <br /> A --- PHOMB&-I <br /> C ADDRESS 800 EAST HWY. 12 <br /> L CROSS $IRIS? LOWER SACRAMENTO ROAD <br /> T OVNER/OPERATOR DONNA TOMPKINS PHONE 1 209-369-3124 <br /> C CONTRACTOR NAME PETROLEUM ENGINEERING, INC. PHONE 1 707-545-0360 <br /> X CONTRACTOR, ADDRESS 11 WEST 9TH, SANTA ROSA CA LIC 1 224358 CLIlS A, B, C10, C61 <br /> 0 INSURER REPUBLIC INDEMNITY 109K.comp.1 PC 988913 12/31/89 <br /> A <br /> t ----= <br /> C FIRE DISTRICT PERMIT I/[NsPTl <br /> I — -- — <br /> 0 LABORATORY NINE DUPONT BIOSYSTEMS 209-368-2731 <br /> SAMPLING FIRM' TRACE LABORATORIES SAMPLING METHOD <br /> TANK LD I ?INK SIZE CHEMICALS STORED CUR9981LI CHEMICALS STORED PRIVIOUIL! <br /> 19- _10,j 000 GALT OvREG GASOLINE <br /> 31. 11-10,000 GALLON U.L. GASOLINE <br /> K 39- -19,000 GALLON U.L. GASOLINE <br /> LIST ADDITIONAL TIMK IXFORXITIOK IS NEEDED 09 SEPARITS Poll <br /> P <br /> L ; -��'APPROVED -- —)IPPROVID fitH CONDITIONS DISAPPROVED <br /> PLAN RETIEVIRS NAME IS ITTACRNIXT WITH COKDITIOII <br /> APPLICANT MUST PERFORM ALL WORK IX ACCURDAXct WITH SAN JOIQUIN COUITY OROINIXCES, STATE LAWS, AND RULES AND REGULIIIOyS <br /> OF ?RR SAN JOAVIN LOCAL RIALTH DjjTRIcT, GYKZR OR LICENSED AGENT'S SIGNAIURR CERTIFIES THE POLLOVIXC; 'I CRRTIFY THAT <br /> IN THE PERFORMANCE OF THE fou FOR valco THIS PERMIT Is Issuto, I SHILL #OT EMPLOY IVY PCRSOJ IN SUCH MilgEl AS 10 BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LIV9 OF CALIFORNIA,' CONTRACTOR'S HIRING OR SURCOMTRACTIJIG SIGNATURE CERTIFIES THE <br /> FOLLOVI"; " CERTIFY THAI 1# THE PERFORMANCE OF THE WORK FOR WHICH IRIS PERMIT IS ISSUED, I SHILL EMPLOY PERSON SUBJRC <br /> TO YORKER'S COMPENSATION LIVS OF CALIFORNIA. I <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> LEM- <br /> OFFtCl USS 00--Eff 23 016 12/SI <br /> COOP I I LOC CODI j DiST CODRI AMOUNT DUE � AMOUNT RCVD <br /> Diff RCVD PERMIT <br />