Laserfiche WebLink
- APPLICATION FOR PER►-� SAN JOAQUIN LOCAL , ALTH DISTRICT , <br /> _ UNDERGROUND TANK '``-� 1601 E HAZELTON AVE. , STOCKTON CA <br /> CLOSURE OR ABANDONMENT Telephone (209 ) 468-3420 <br /> IPPLICITIOI POR PIRNAIIIT/TINPORIIT CLOSU11 OR 1111001MIIT 11 PLIC& Of UNDIRGROUID RAIARDOUS SUISTIICIS STOIIC& PICILITI <br /> f11S PIR T IIPIIIS 11 DAIS 1101 ill 1PPIOTIL DIT&. DO BOT TRITE II 111 SIIDID IRIS- IIDICITS PIRRIT TIPS ISLOT: <br /> REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> F PROJECT CONTACT Axp PHONE 1 410!5-- <br /> A <br /> C FACILITY NAME��G"I ADDRESSMA�I - <br /> I <br /> L CROSS STREET PHONE 0_f Z5A ME <br /> I <br /> T OWNER PHONE 1 <br /> Y kt-5 e- A-Yesic <br /> C CONTRACTOR NAME PHONE 1 <br /> 0 NO-ZTH G4 L <br /> N CONTRACTOR ADDRESS O,f;Ox CA LIC 1 <br /> T <br /> R LIC CLASS Ar WORK. COMP. <br /> A 0 Cg q pp_ygq 1 INSURER l o,do3frlaG <br /> C FIRE DISTRICTFARMIIJGt-Tb�t �-ttZ� PERMIT 1 <br /> ckd <br /> T �ExiPT. <br /> 0 LABORATORY NAME $G4iN TSN/gwg-METPa1C PHONE 1 <br /> SEiZU <br /> R (CES _ INC. ? / 91 — 1le(q <br /> SAMPLERS NAME SAMPLING METHOD <br /> C VOLUME CHEMICALS STORED DATES STORED CHEMICALS STORED <br /> H ID 1 CURRENTLY <br /> E PREVIOUSLY <br /> M 3°I-ZZ I OOd CTA L _TO _ SIOM6 <br /> I -z -oQW QAW =g Ant TO <br /> CTO <br /> A <br /> L -- TO______-_ <br /> LIS ANY EXTRA TANKS ON A SEPERATE SH ET <br /> PPPROVED J <br /> L (SEE TTACHMFW TH CONDITIONS) <br /> A PLAN REVIEWERS NAME & <br /> N DATE <br /> 1PPLICItt MUJf PIRIORK ILL roll 1E 1000RD1ICt rill SII JOIOUIE COUITI OlDIM1rell, Stift LIrS, LID RULE$ AND RECULITIOls <br /> OP tit Jit J010911 LOC1L 1IILTI DISTRICT. OFIER OR LICEISED ICIIT'S SICIITUR6 CEIf1PIS1 TAR 1OLLOrIRG: 'I CSRTIyI TRif <br /> It fit PERPORXIECt of TRS TORI lot r110E firs PtIMIT Is ISSUED, I SULL for Imor III PIRSOr 11 SUCE NIEIER 1S t0 I100Xl <br /> JUIJRCf TO rORIKIIII CONPIIJITIDI Lill O/ CALI►011I1.' 0I1110OR'S 1111m OR 101-CONTR1cuic SICIITURE ClITI11ES TRE <br /> ►OLLOrIIC: '1 CtRf1►T fill Ir TES Ptl►ORxIECE O1 111 1011 ►OR 111Cl III$ PURIT IS ISSUED, I SEILL "PLOT PIRSOIS SUIJtCf <br /> TO rORIEIE'1 COKPIIJIf10l Lill OP C1L1101111. COIPLEII DIIr11C OE 1ffAcuo PLOP PLIl Silly. <br /> CALL FOR ALL NECESSARY INSPECTIONS AT LEAST 48 HOURS IN ADVANCE - <br /> SIGNED X TITLE: DATE: <br /> ACCEPTED BY TITLE: DATE: <br /> PF RN 1 I I J I I �L'��l\l'►� „- <br />