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• •� .tea: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br /> THE PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK <br /> EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> X REMOVAL TEMPORARY CLOSURE CLOSURE IN PLACE <br /> EPA SITE 0 CAC 001415264 PROJECT CONTACT i TELEPHONE N Jim Thorpe Oi�1 , Inc. (209) 368-6175 <br /> F FACILITY NAME American Transfer Company PHONE # (209)466-0111. <br /> d A <br /> C ADDRESS 2701 Highway 99 South, Stockton, CA 95215 <br /> t <br /> L CROSS STREET Mariposa Rd. <br /> I <br /> YOWNER/OPERATOR Same as above PHONE # (209)466-0111 <br /> OC CONTRACTOR NAME Jim Thorpe Oil , -Inc. PHONE 0 (209) 368-6175 j <br /> N CONTRACTOR ADDRESS p. 0. Box 357, Lodi , CA 95241 CA LIC x 495699 CLASS A, B, Ha2. <br /> T <br /> R INSURER Firemans Fund/GenstarWORK.COMP.# 007197-97 <br /> A <br />' C FIRE DISTRICT The City of Stockton PERMIT # upon approval <br /> T1,SAMPLING <br /> LABORATORY NAMEGeoAnalytical Labs C011NTY San Joaquin PMO"£ (209) 572-0900 <br /> GG ay111111111�1� �I6 cal Laboratories PHONE # (209) 572-0900 <br /> TANK ID 0 TANK SIZE CHEMICALS STORED CURRENT Y/PREVIOUSLY DATE UST INSTALLED <br /> 39 10,000 gallons diesel fue uk <br /> T 39- 1 -9nn gallons d' s l fuel rnk <br /> A 39- <br /> N 39- <br /> K 39- <br /> 39- <br /> 39- <br /> P 1111 I I I <br /> L APPROVED _ APPROVED WITH CONDITIONS) DISAPPROVED <br /> A (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) <br /> N -- , <br /> PLAN REVIEWER'S NAME DATE <br /> Illllitlllllllllrllllllll111111111111111111I111illlll! II III1111111111lI1111111lllil11111111111111111111111111111111111111 <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING. "I 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'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORN <br /> APPLICANT'S SIGNATURE: TITLE Contractor/Agent DATE <br /> CONDITION(S): �. <br /> APR 16 18S-18 <br /> ,mo i'':•`•f 1x0I!V< - t <br /> F.�f;'; <br /> PE - -- <br /> EN 23 046 (Revised MUM Page 3 <br />