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APPLICATION FOR PERNfrT SAN JOAQUIN LOCAL -HEALTH DISTRICT <br /> UNDERGROUND TANK 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone (209) 468-3420 <br /> 1PPLICITIOI tot P11111t11/TtXP0111I CLOSU1t OR 1111DOIXt1f 11 PLIC/ Of U9099GRODID IIIIRDOOS SUISTIICIS S10RIGt PICILITI <br /> THIS PERMIT ITPIIIS 10 DIIS 1901 ?It IPPROTIL D1TI. DO ROT TRITE II 111 SI1DI1 IRtIS. IIDICITI PIRMIT TIPE BELOT: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT Claudio De va <br /> A Modesto Dry Ice PHONE # 415 / 586-0639 <br /> C FACILITY NAME Modesto Dry Ice ADDRESS 260 S. Main St. , Manteca <br /> I <br /> L CROSS STREET PHONE <br /> I <br /> T OWNER PHONE # 415 / 586-0639 <br /> Y Angela M. Casazza <br /> 530 Yale St. , San Francisco, CA 94134 <br /> C CONTRACTOR NAME Jim Thorpe Oil , Inc. PHONE # 209/ 462-4581 <br /> 0 <br /> N CONTRACTOR ADDRESS 351 N. Beckman Road, Lodi , CA CA LIC # 495699 <br /> T <br /> R LIC CLASS A WORK . COMP. # on file INSURER on f le <br /> A <br /> C FIRE DISTRICT Manteca Fire Dept. PERMIT # <br /> T <br /> 0 LABORATORY NAME Canonie Env. PHONE 1209 983-1340 <br /> R <br /> SAMPLERS NAME SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID # CURRENTLY PREVIOUSLY <br /> E <br /> M 2 550 Regular Gas _TO 1982 - <br /> I TO <br /> C TO <br /> A TO <br /> L LISt ANY EXTRA TANKS ON A SEPERATE SHEET <br /> PN <br /> L (SEE ATT Q#HENT WIT COND TIONS) <br /> A PLAN REVIEWERS NAME DATE"/IBM GEN 111211111mizi <br /> N <br /> IPPLICIII IUSI PIRPORI ILL FORK II ICCOROIICt till Sll JO1QUIl COUItT 0101111CIS, Stitt Lin, RID RULES ARD ISCULITIO13 <br /> OP 111 111 JOIDUII LOC1L It1LTl DISTRICT. DtIIR 01 LICIISID 1CIIf'S SICl1TURl CIIfIFIU RIR tOLLOY1lC: 'I CIRfIFI THIl <br /> 11 fRI PIRFOULICE OP Tit YORK FOR tllCl /IIS PIR111 IS ISSUED, I STILL tot IXPLOT IIT PI1SO1 11 SUCH X11111 1S TO IKONS <br /> SUBJICt TO YORKXII1l COXPKISITIOI L1/S O1 CILIFORIII.I C0111100R'S IIIIIC OR SOl-COHnICTIIC SICIIIURI CIITIFIIS TBI <br /> FOLLOYIIC: 11 CIRTItT flit II fig PIRFORXIICI O1 fit YORK POR PIKE tits PIRHIT IS ISSUED, I S/ILL EXPLOT PIRSOIS SUBJECT <br /> l0 tORIXlI'S COXPIISITIOI 111S O1 C1LI1021I1. COIPLITI DRIYIIG O1 1TTICUD PLOT ?LII 1111/. <br /> CALL FOR ALL NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SIGNED X TITLE: DATE: <br /> ACCEPTED BY TITLE: DATE: <br />