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ENVIRONMENTAL NEALiN DIVISION <br /> APPLICATION raft UNDERGROUND STORAGE ?AUK CLOSURE PERMIT <br /> ArrI.ICATTON FOR rER}IANF.NT/1EHhogARY rtoSURE OR AIIAI1009MFMI IN PLACE Of U11DERDRt1UFID HAZARDOUS SUBSTANCE STORAGE ?ARK <br /> 11114 rERMIi EXPIRES 90 DAYS rftOH TIME APPROVAL DATE. DO NOT %+RITE IN ANY SHADED AREAS. INDICATE PERMIi TYPE iIELOVI <br /> X REMOVAL TEMPORARY CLOSURE CLOSURE iN PLACE <br /> 1:hA RIiF. # PROJECT CONTACT R Tf.LEPIIaNE 1< <br /> - .-_CA17 n4 �74 481 rP� (?Q9�3�i2�7? <br /> T W11.1 t r NA11x Teresi Trucking PNoNE 0 (209)368-2472 <br /> A <br /> r, Anngess 900 112 E. Victor Rd. Lodi, CA 95240 <br /> l t"05n R14EFT Beckman Rd. <br /> t OWWR/nPFRAtoR PHONE N <br /> r Teresi Trucking (209)368-2472 <br /> c r,n111RAr,tOR NAME JIM THORPE OIL, INC. PHONE 6175 <br /> N f.N1TRAi1Uq ADDRESS 351 N. Beckman Rd. , Lodi, CA 95240 to LIC #495699 CLAssA B Haz <br /> 1 - —.— <br /> A IilsnaF Genstar LlONK.co11r.� <br /> C FIRE D1srR1rT The City Of Lodi rERMTt I <br /> Upon approval ofof plarL <br /> D i.ARiiRAtonr NAi1F GeoArnalytical Laboratories PHONE * 20 - <br /> q - - <br /> f!'1f1 l iFO F IP1� PNONF R <br /> ilNlllllll�lll�tl�lllllilllll GeoAnal tical Laboratoriesq72—nonn <br /> I NK D I(I�K WE C11�1)ICAt�sTORED CURRENiLY/pREYIOUSLY DAi�UST INSTALLED <br /> Jo 1 r�f7-1- 1 , U iesLe u <br /> 1 !?- 1-7Y7 _ L _ 1010uu diesel u <br /> H 37.17 - 5,nnn iit< _ <br /> p iilllllllllllllllllll[iIiIiIil II11111111[IIIIIiiIIIIiIIIIIIIII ill[Illtit[I111[ltlllllllll[IIIIIiIIII� Ittillttti[it[tlltlll <br /> ! 'K Artpovto APPROVED WI?N C01MItION(s) DISAPPROVED <br /> A <br /> %SEE ATTACIMENr Vi TN CONDITIONS) <br /> N ti All PFvfrvtpS Mfr+rDATE !r moi <br /> - Illllllllllllfllllllll "111111151:111i itttltttrlttttlt Ittttttittittttit�Ittttnl�I�II[ttttt 1461ttttttttttttt <br /> AirtiCAtll 1dIST rwoRii ALL WRK IN ArCORDANCE u1111 SAN JOAO1JIS CoUP11Y ORDINANCES, 9fATE LAWS, AND RULES AND REGULATIONS OF <br /> SA4 JUARUIII COUNTY PUBLir HEA11N SERViCF,S. Ou11ER OR tiCENSEo AGFNT'S SIGNATURE cERTI1IEs THE FOLLOVIN01 *1 CERTIFY 1HAt IN <br /> 111E PER1oR1WWF DT THE Mint FOR 1111frH 11115 PERT11f IS ISSUED, i SHAi.L NOT EMPLOY ANY PERSON iN SUCH A MANNER AS 10 tE6T1ME <br /> SURJEt? TO va"tER'4 CCF1rtRSATI(IN tAU1 Or CAI.IFURi+IA." CORIRACTOR'S RIRIN9 OR SURCONTRAC?INn 310MAiVRE CERTIFIES iNE rOLLONINGt <br /> "I ttftlIrY 111A1 iN 111E rERfoRiIANCF or 111E T7URK fon vHIcN THIS pERMr? IS ISSUED, I SHALL EMPLOY PERSONS SUNJECT IO I?URKER'S <br /> r"ttlNSAIWIf %AUS or tALIrogNIA.0f <br /> �hhllr,ARl'S SfGNAfURE? f111E Contractor DALE 10/27/95 <br /> R r.3 ne6 (Revl-Red 8/26/981 Page 3 <br />