Laserfiche WebLink
nrrULA]1Uh FOk PERMIT E} SAN JOAQUIN LOCAL HEALf 6I8TRIC1 u <br /> a UHDERGR��, TANK r 1601 E HAZELTON AVE., STOCIf - <br /> ' CLOSURE WDONMENT Telephone (2091 X68-3#lv L' <br /> K>r►x►x►r►�t�x►xn►rrarrx►x►x►r►x►xn►r►x►}>r»►r►x►x►x►rrrrx►rrx►x <br /> NOV 2g 1989 <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES�ST A IIITM <br /> THIS PERMIT EIPIRES 90 DAYS FRO THE APPROVAL DATE. 00 NOT WRITE 1N ANY SHADED AREAS. INDICATE Piked' r VICES <br /> ____ REMOVAL _____ TEMPORARY CLOSURE ____ ABANDONMENT IN PLACE <br /> EPA SITE L,4E j � g� s �6 PROJECT CONTACT t TELEPHONE # RCI L _33,( O p g7 <br /> F FACILITY NAME G 6 W z K C- / PHONE # 7 7 ! <br /> A v f �d� - 9 3LI - 6 SO U u <br /> C ADDRESS �LE g KE ((l L� I'r�rri t�L LLQ rJ ti In <br /> I 9 !3 R L41 <br /> L CROSS STREET _S_ Q-�,� T9, � <br /> I �7 <br /> IT OWNER/OPERATOR PHONE # <br /> Y A (�V� G� L.��. �-�. coq - 331 - 65� v <br /> TCONTRACTOk <br /> R NAME PHONE # <br /> azfr-sz4-'�(Os3 <br /> ADDRESS y31 (� Q-�--O CA LIC 14ygtay CLASS <br /> ' nj <br /> A <br /> C FIRE DISTRICT L 00 PERMIT #IIkSPTR <br /> T <br /> 0 LABORATORY NAME C r4L I;� qT� 2 <br /> R �..R Fj � PHONE # a�� _ Sn'�7- �-{�C� 5� <br /> SAMPLING FIRMt CALIF WAT�� L�(� SAMPLING METHOD <br /> TANK ID # TANK SIZE CHEMICALS STORED CURRENTL CHEMICALS STORED PREVIOUSL <br /> T 3 <br /> H 34- c f---_�_�------ S So t_ <br /> K 39- <br /> 39 <br /> 34--------------------------- - - -- <br /> - - LIST ADDITIONAL TANK INFORMATION AS HEEDED ON SEPARATE FORM <br /> nmmamimamli <br /> L __ APPROVED __ APPROVED WITH CONDITIONS DISAPPROVED <br /> L (S�TTACHMEXT- ITH GOHDITIOHSI-+- <br /> A PLAN REVIEWERS NAME ___ ----_- <br /> N - ------- - ---------------------DATE----la�_7_�_�' - <br /> mummal,111011 JIM <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE 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 TO BECOM <br /> SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA,' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES IHE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> i <br /> C OR INSPE TIONS AT LEAST 48 HOURS IN ADVANCE <br /> �IGNEO- _ r --C-V--�.L _ ----------- _ <br /> �CI USE ONLY--EM 23 0/6 12188 ----------»---------------- DATE J � —a�7 <br /> sssssstsstsssssssssssssssssssstttsssssssssstsssttssssssssstttsssstsstsssttttssssstststttttssssssssssssssssssssssssss <br /> uEEPS COMA CODE DIST CODE AMOUNT DUE AMOUNT RCVD CKI/CASH RCVD BY DATE RCVD PERMIT # <br />