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• SAN %QUIN COUNTY PUBLIC HEALT ;ERVICES <br /> ENVIRONMENTAL HF-ALTH DIVIb,0N <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br /> STORAGE TANK(S)EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE: <br /> ] REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br /> FACILITY INFORMATION <br /> EPA SITE# CAC002559766 I PROJECT CONTACT John Ridenhour PHONE# _ <br /> FACILITY NAME S. T. Services IPHONE# <br /> ADDRESS 3505 Navy Dr. , Stockton, CA 95206 <br /> CROSS STREET wasningl—on-7T7. <br /> OWNER OPERATOR 3. ervlceS I PHONE# (209)943-5662 <br /> CONTRACTOR INFORMATION _ <br /> CONTRACTOR NAME lm Thorpe Oil , Inc. I PHONE# 209 368-6175 <br /> CONTRACTOR ADDRESS - _ CA LIC#, 49569q I CLASS A B HAZ <br /> INSURERAmerican Internat ' l S ec.Lines WORKERCOMP# State Funa 1671173-02 <br /> FIRE DISTRICT PERMIT# Upon APP roval <br /> LABORATORY NAME GeoAnalyt ical Labs COUNTY Stan I PHONE# (209) 572-0900 <br /> SAMPLING FIRM GeoAnal tical Laboratories PHONE # (209)372-0900 <br /> TANK INFORMATION <br /> TANK ID# TANK SIZE TANK CONTENTS PRESENT& PAST DATE INSTALLED <br /> 39-DI ��� 550 Gallon Gasoline Vapor Tank UK <br /> 39- � Ll �� a on Diesel Heating Oil UK <br /> 39- <br /> 39- <br /> 39- <br /> 39- <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS. FEDERAL LAWS,AND RULES AND <br /> REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "1 <br /> CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS <br /> TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKER'S COMPENSATION LAWS OF IA.' <br /> APPLICANT'S SIGNATURE TITLE Contractor DATE 12/11/02 <br /> ❑ APPROVED APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br /> (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> PLAN REVIEWER'S NAME !2L/✓1 . ( -� DATE 12- 2�0 0aZ <br /> ANY DEVIATIONS FROM THIS APPLICATION MUST BE SUBMITTED TO EHD FOR APPROVAL PRIOR TO COMMENCING WORK. <br /> CONDITIONS: <br /> - <br /> EH 23 046(REVISED 08/13/99) Page 3 <br />