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R:R:R:ti:L 41:R:R:t1l:R.:R:R:Vk ft R:et:t1:ff R:R:ff R:R:R:R:ft L A:R:R: <br /> APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISfRIC%: <br /> UNDBROROUND TAN( t 1601 & HAllLTON APB., STOCKTON CAt: <br /> t: CLOSURE OR ABANDONMENT t: Telephone (209) 468-3420 t: <br /> t:ft:R:%X ff R:R:t-1:R:Vt:tit:R:R:R:tl:R:RI:R:kl:t-1:R ti:R:R:R:R:R:RI:R:R:R:ff R: <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT V1l?8 IN III SHADED AREAS. INDICATE PERMIT TYPE BELOW., <br /> XX REMOVALTEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> ----- Bar hausen Eng' <br /> EPA SITE I PROJECT CONTACT & TELEPHONE I Frances W. Hedrick <br /> (916) 348-3057 <br /> F f FACILITY MAKE PHO <br /> ARCO Facility # 6020 HE 1 (209) 823-4715 <br /> C ADDRESS 1711 E. Yosemite Ave. <br /> I <br /> L CROSS STREET Highway 99 <br /> I <br /> T OWNER/OPERATOR PHONE I c/o Barg-Rausen Engineers <br /> T Atlantic Richfield Company (916) 348-3057 <br /> C CONTRACTOR RIM8 PHONE I <br /> 0 <br /> I CONTRACTOR ADDRESS CA LIC I <br /> R INSURER VORK.COMP.1 <br /> C FIRE DISTRICTCity of Mantica Fire Dept. PERMIT I/IMSPTR <br /> 0 LABORATORY MINE Enviornmental Laboratories HOWE 1 (916) 452-2901 <br /> R SAMPLING FIRM= SAMPLING METHOD TPH-5030 TEL-DOHS LUFT <br /> A lied Ge systems --[-- BETX-8020 EDB-DOHS AB1803 <br /> TANK ID I TANK Slig CHEMICALS STORED CURRENTLY CHEMICALS STORED PREM OUSP <br /> 6,000 gal. Regular Gasoline Same <br /> 6,000Sufic unleaded -- Go rn e <br /> K 39- 61000 _,�a ew e <br /> 39- 1102000 Unleaded Gasoline Same <br /> 39 <br /> LIST ADDITIONAL TANK INFORNITION AS NEEDED ON SEPARATE FORK <br /> P APPROVED _APPROVED WITH CONDITIONS DISAPPROVED <br /> L (SEE ATTACHMENT WITH COXDITiOVS) <br /> IIPLAN REVIEWERS RINK DATE <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LIVS, AND RULES AND REGULATIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CERTIFY THAT <br /> 18 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 THE <br /> FOLLOWING: 11 CERTIFY THAT IN THE PERFORMANCE OF THE YORK FOP WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC4 <br /> TO WORKER'S COMPENSATION LAYS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> —Agent for ARCO 10-4-90 <br /> OFFICE USE ONL11­911 23 046 12181 <br /> SWEEPS I COMP I iLOC CODE DIST C0.1 AMOUNT DUE AMOUNT RCVD CKI/CASH RCVD BY DATE RCVD PERMIT I <br />