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►YLJENT <br /> RECEIVED <br /> NOV 13 1992 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SCRVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK i <br /> THIS PERMIT EXPIRES ,TSO DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELAY: <br /> X REMOVAL TEMPORARY CLOSURE CLOSURE IN PUKE i <br /> EPA SITE # C..AD809137126 PROJECT CONTACT i TELEPHONE t Tom Juano (209) 956-4751 <br /> F FACILITY NAME $tio ktora Steed PHONE # (209 956-4751 <br /> A - <br /> C ADDRESS 3003 E. Hammer Lane Stockton, CA <br /> I <br /> L CROSS STREET Holman Road <br /> I <br /> T OWNER/OPERATOR PHONE i <br /> Y He ,Tom Juano 209 956-4751 <br /> C CONTRACTOR NAME DECON Environmental 'Services, Inc. PHONE 0 (510) 732-6444 <br /> � o <br /> N CONTRACTOR ADDRESS 23490 Connecticut Street LIC # 545726 CLASS A <br /> T <br /> R INSURER State Compensation Insurance Fund WORK•COMP•# 430-92 Unit 26 <br /> A <br /> C FIRE DISTRICT Stockton Fire Department PERMIT S <br /> T <br /> ♦R LABORATORY NAME Sequoia PHONE iF (415) 364-9600 <br /> SAMPLIN& FIRM H O Geol Gary Lowe PHONE S (510). 373-9211, <br /> 11l1111illlll Illilll�tlllllll! <br /> TANK ID S TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> 39- 101000 n esel A rox. March <br /> T 39- 8.11011 n;1-01 70-- <br /> A 39- 7,nnn _. _ . T)i ese, _ }EiRft r <br /> H 39- el 1(),1111n TTnI t5Ad rl rA.-; <br /> K 39- <br /> 39- <br /> 39- <br /> II11 <br /> P <br /> L APPROVEDAPPROVED WITH CONDITIONCS) _DISAPPROVED <br /> A TT CHMEHT WITH CONDITIONS) <br /> N PLAN REVIEWERS NAME DATE <br /> !!llllll!l1111l1!!11 Illl! <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAH JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: at CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'$ HIRING OR SUBCONTRACTING SIGNATURECERTIFIES THE FOLLOWING: <br /> Of CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS.: <br /> `SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORNIA." <br /> APPLICANT'S SIGNATUR§:.:7 TITLE SV1W11Z_5CW DATE <br /> EH 23 046 (Revised 7/10/92) P"e 3 <br /> �, z�'_�-.•'--;-.�'_'�'L1t;e-�- -�'-z --���=�'T�f-- ...:._._"_'_..'^v�.:-�^�T..����i-Vii._-.. - -. _.._.-_ "�- ,...__.. ,--�+;.;:.�.•�F ;:�-.=>� <br />