Laserfiche WebLink
i - <br /> • k�kt�kt�kt ka kfi�kt�Ct ttt�kt�L't L't�kt�kt�kt'L't�kt�kt L't�tt�kt�kt�kt�kt�kfi:k' :k <br /> APPLICA,.,iN FOR PERMIT SAN JOAQUIN LOCAL HEALTH __sT u N <br /> k UNDERGROUND TANK k: 1601 E HAZELTON AVB., STOCKTO v v o <br /> k: CLOSURE OR ABANDONMENT k: Telephone (209) 168-3120 k: <br /> k:kt ft kt ft kt ft ti:kt ft ktt kt kt ft ft ti:kt kt LI:L't:LI:kt kt:L't R:kt RI:kt:kt:kt:ti:kt'kt S C P 251989 <br /> APPLICATION FOR PRRMAKENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZAt <br /> � ST}Oi)kkgACILITY <br /> THIS PERMIT BKPIRES 90 DAYS FROM THE APPROVAL DATB. DO NOT WRITE IN III SHADED AREAS. DICI� R1� � �P�BSBBLOW: <br /> X REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> EPA SITE B PROJECT CONTACT i TELEPHONE I A L�EX4_Lo�huE.'Z__ <br /> CL Act D�-1��> f�G7�I .�_._I_._—....__- ----- -(3,CP6 1�-13- L.- �1 <br /> F FACILITY NAME <br /> A — S �KT��nI ._L CPD�_.k —_ PHONE I aD9 �' - 1o3�L�_ -- <br /> C ADDRESS SLS f I UC,K I L) <br /> L CROSS STREET <br /> -- <br /> 1 OWNER/OPERATOR PHONE I <br /> Aco.�E <br /> C CONTRACTOR NAMEt��EC iS1 bAI U5i ��['S �jnl C PHoee I a lq- , (0 j,- qq 1 I <br /> �1 S L�SIi 1 Pil(s, R�l�. <br /> N CONTRACTOR ADDRESS i CA LIC I ��-� �q <br /> �-Cucroko�l ,1���iv-- � CLASS A � <br /> q ....._..........................____ <br /> R INSURER D LAS U)4t~l'I ono WORLCOMPA (.0 L. ul� <br /> C PARE DISTRICT S t oC-C �Y� C Cl l y Dt' ) PERMIT I/INSPTR <br /> 0 LABORATORY NAME DLSPHONE 1at779 _ q.5 _ �LjUS <br /> R _—__ __—. I� ------ -- __. _ <br /> SAMPLING FIRM' SAMPLING METHOD P h�SS 6LS <br /> -•— IOHY,!!WIOIYOIINtlIWIHWNpUI�IIIIIIIItltlItlIR108tlRNtl!Itl01WINIliWOYUiItlI - ---.-______ _�-- -- I� —_ _..___._.----•.--._._.. <br /> TANK ID I TAKK SITE CHEMICALS STORED CURRENTLI CHEMICALS STORED PRE'/IOUSL <br /> f <br /> A 39- ID,DDD 6 A kI 5.-CEL _ UIL 6ASQL1k1L _ —^— ---- <br /> W 35- <br /> K9-K 3 9-------- _-------- – ---- -- <br /> 39- <br /> -- — __ LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORK <br /> IIHUYOIHIIIIIHkIYNtlIIHHItlIIIHHIIIUIIIIHIHW1HHtlNHIUWHIIRtlIHIRIIHIlUU.01W11 HHIIi�IIWIIIiIIIIIIHIIHil1111!!iHICIIIHtli!I!HIIII!IUIIHIIIktlHH!IkHI!JIHGIUiIHIIIUIiUHHlklklaitlu�'iH!!Hi!C!II!!NII!IJ!uJklHullUlllL'HAUL'IlYill!1!IIWItltIH!IHIUHHI!!tlIICWkiHh!1!1!uH!IIH!tllYIIIHIIIL!' <br /> P _ APPROVED APPROVED WITH CONDITIONS _— DISAPPROVED <br /> L WE ATTACIIMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NINE !��z —�–_– _----DATE <br /> – '�–�–�/�--- <br /> HWWItlRHtlIIWNtlRRHYIRNItlWWWYOtlWYtlIgNItlWWtlIWIIWtltlIUtlWKHIWtlWIYlBtltltltlRRtltl '' 'III�IHlW�HIRtlIWWIWJIWRIBtlUIkNItlklRf�WWIWIAItlIfWIBWIYYIIIGBNNNIIHIrW!W!�YWtlIfN <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATUR9 CERTIFIES THB FOLLOWING: 'I CERTIFY THAT <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS f0 BECOM <br /> SUBJECT TO YORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERNIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA° <br /> CALL FOR INSPECTIONS AT LEAST 48 IIOURS IN ADVANCE <br /> SIGNED_— �� --------_—_–__ —DATB–�°Z J- �---- <br /> OFFICE USE ONLY--EH 23 016 J21P /� <br /> SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSy��SSSSSSSSSSSSSSSSSSSSSSS$SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS <br /> SWEEPS ( COMP ( LOC CODE DIST C008' AMOUNT DUBAMOUNT RCVD CK1/CASH RCVD BY DATE RCVD PERMIT <br />