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MAP 13 '85 14:56 PETROLEI_i, ENGINEERING 7075457068 P.4 <br /> t R 1 kvtt1k:R R k:t t1 ktti0 kl�tt Lt 4k 91'tt kt'tt kfi k7 tt kR kt tt�fft.1 Vt1;tvkV <br /> k APPLICATION FOR PERMIT t; SIN J01060 LOCAL HEALTH DISTRICT V. <br /> t; UNDERGROUND TANK t; 1641 I HA116TOR A71.1 STOCKTON CAI; <br /> t; CLOSURE OR ABANDONMENT I Telephone 12091 168-3421 I; <br /> I;k1'kt�R;LIT R k1�tt;III kt:k1l,ft tt'tt ft R:IVR,rk!VVRiak-l!a Vv IV R:R:I It,it.tt tt <br /> APPLICATION FOR PERNANEXT/TEMPORIRY CLOSURE 09 0AIDONMENT IN PLACE OF UNDERGROUND RA8110OUS SUBSTANCES STORAGE FICILITT <br /> THIS PERMIT SIPIRBS 90 DAYS FROM THE APPROVAL DATE, DO NOT MTI IN 111 911011 AREAS. INDICATE PERMIT TYPE 111,011: <br /> REMOVAL -„-_, TEMPORARY CLOSURE ABANDONNBNT IN PLICI <br /> "I.Y.3""�`:��-����...—�•_..�'T.'�'9' n'P4'.�'11CaG:ca'r.til."t_"W7%:7'::x::-�'�_._.�'„�RC7's�_`�.._:�_ _-.'--..-" _—�..:�C= <br /> IPA SITE I CAL 000003403 PROJECT COBtICT i TELEPHONE I JOE COX 714-634-4800 <br /> F PACIGITY NAME "FAST GAS" PHONE I 209-369-3124 <br /> C ADDRESS 800 EAST HWY. 12 <br /> L CROSS STRNRT LOWER SACRAMENTO ROAD <br /> I <br /> T OVNERIOPERATOR DONNA TOM.PKINS PHONE 1 209-369-3124 <br /> 1 <br /> �x �'..:,`'.s—:..—.._,—..�_�,�.�_.�—.._....._,�.��..,�._.._:_"�.�;.,"•^."-�f70-^T�:.3tv71nrWt]:: _.:��'OGtL-:_—_...._........�.�:a7.^.E.tl'R�P� <br /> C CONTRACTOR KARR PETROLEUM ENGINEERING, INC. pHONC 1 707-545-0360 <br /> N CONTRACTOR ADDRESS 11 WEST 9TH, SANTA ROSA CA LIC 1 -224358 CLAAS A, B, C10, C61 <br /> R INSVIER REPUBLIC INDEMNITY - VORN,COMP.1 PC 988913 12/31/89 <br /> C FERE DISTRICT PERMIT I/INSPtR <br /> T <br /> 0 LABORATORY NINE DUPONT BIOSYSTEMS PHONE 1 209-368-2731 <br /> R <br /> �SIMPLING FIRK' TRACE LABORATORIES SIMPLING METHOD <br /> W,—i�S!^NNugngln;(rinllnnnglglalElqlmIlNN#INQI;ll1RIInAl11n10RNIIBg11DID11 �---»�"��.--�M»-��.-.--- .-.-.. .--- .�.--..� "----- <br /> TANK ID I TANK $IIE CHEMICALS STORED CURRtNTLI CHEMICALS STORED PREVIOUSL <br /> T 10 000 GALLON <br /> 1 39 i REG. GASOLINE <br /> K 139--_----" 1p'���,GALLON T� SUP.�U,L. GASOLINE <br /> 10 000 L Qv L,I . GA—SALINE <br /> 12,000 GALLON DIESEL FUEL <br /> LIST ADDITIONAL TAMK INFORMATION 1S NEEDED 08 SEPARATE FORN <br /> .-YglluEllzfil@a:llllnfnll?akilllllgiplilg1l111N!IlgUgnlilllpnlUOlUHllnllilpRlNNlga, IU�IInIMIINgnnnlfllBl!IlglnnilNlglllinglf1111nplqtllllllPlq�1411UCiialli!IglntgmlakllRfglltpll➢1IgInIIIB@IpgltlgnnnllgqqllJLhnB(IIUp61nlgnitlllgplgqqSlllqqlahN'BgInBDItlIpINn(IIYIMIIkURII <br /> LII APPROPBO _ IPPRODBD WITH CONDITIONS _ DISAPPROVED <br /> ��- )SEE ITTACHNENT 11IN CONDITIONS) _ <br /> A PLAN RIVIEVIRS NINE <br /> -�-diliil!ulVaalllmiflu�tllBnaNMliNlu��ntlalIII>ailHi�nUpl�la�u@uoWgngllNRgdqRlnN�mlqlqllgllRn�aglllNglgM!>9111AI1mIIgVIq�nNuuInBRI1rq�IglD�7lNINltrtQlpllal�lnDa�lamE��,yR�IfI�IGmakRUAgIIEn�61ulOIgI�1gRp1UIIIINI�UIDpplill�IlgaBgglfllNqllNl!ql�qryi�l <br /> APPLICANT RUST PERFORM ILL WORT( IN ACCORDANCE YITR SAN JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES AND REGULItIONS <br /> OF TAR SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICEKSED AGENT'S SIGNATURE CERTIFIES THE FOLLOVING: 'I CERTIFY THAT <br /> 18 99 PERFORMANCE OF THE WORK FOR YHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY All PEISON IN SUCH MANNER AS TO BECOM <br /> SUBJECT TO YORKER'S COMPENSITION LIVE OF CALIFORNIA.' CONTRICtOR'S HIRING OR SUBCO979ACT1KC SIGNATURE CERTIFIES THE <br /> FOLLOVING: 'I CERTIFY TN&T IN ?At PERFORMANCE OF Thl WORK FOR 1NICH THIS PERMIT I' ISSUED, I SHILL EMPLOY PERSONS SUBJEC <br /> TO WORKERS CORPENSITION LAWS OF CAL1FORII1, <br /> CALL FOR INS[? CTI ONS AT LEAST 48 HOURS IN ADVANCR <br /> SIGNEOr r <br /> ' OATS _ <br /> OFFICE USE ONLY.-III 23 016 12181 <br /> SSSSSSSSSSSSS9S893SS99SSsiSSSSSSS3SSSSSSSSSS99SSSS9SSSSSSSSSSS9SSS39S99SSSSSSSSSSSSSSSSSSSSSSSSSSS9999SSSSS9SSSSSSSSISSSS <br /> �SWBEP3 I j COMP I I LOC CODE I DIST COO11 IMOUNT OUR AMOUNT RCVD I CKIJCASH I RCYD BY I DITR RCVD I PERMIT I <br />