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�r yavavr,a � nunnuunn[nfi icirpnunr �av�i �uu arm � <br /> r: ri<nftsrnnlfai. :r+:"f:ll!!fi>'!F" fi7�'!MllfifinllKlifi lElffF!:!ll:gflil SfSt!llHogg$ Y'Mion <br /> APPLICATION FOR PERMANENTITEMFORARY CLOS OR ABANDONMENT IN PLACE OF UNDERGROUND HAiAd- US SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 30 DAYS FROM THE APPROVAL DATE. DO NOT WRITE.IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br /> -X- REMOVAL TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> ' EPA SITE I PP,OJECT CONTACT i TELEPHONE I <br /> CAC-000-147893 Geor e Jemson (714)-385-5.725 <br /> F FACILITY NAME Tura Scudders PHONE 1 (209) 835-6300 <br /> A <br /> C ADDRESS 100 valpico Road, Tracy, California <br /> I <br /> L CROSS STREET Tracy Boulevard <br /> T OWNER/OPERATOR same as above PHONE I same as above <br /> Y <br /> C CONTRACTOR HAMS Precision Industries, Inc. PHONE I (209) 462-9911 <br /> 0 _ . <br /> H CONTRACTOR ADDRESS 1041 S. Pershinc Ave., Stockton CA LIC 1 467293 CLASS I B <br /> f T <br /> P INSURER Ohio Casualty WORK.COMP-f x(89)400-96-87 <br /> A _ <br /> C FIRE DISTRICT Tracy Fire PERMIT 11[NSPTR . <br /> T -- ---- ------ <br /> 0 LABORATORY NAMERoy F Weston PHONE 1 (209) .957-3405 <br /> [ R <br /> SAMPLING FIRM* Roy F. Weston SAMPLING METHOD brass tube <br /> + TANK ID I TANK SIIE CHEMICALS STORED CURRENTLY CHEMICALS STOPED PREVIOUSLY <br /> A J�-___l ----2 ___--�}- _ 2 � Iov� diesel fuel _ diesel fuel <br /> II <br /> - <br /> ___� _-�' /-- ,000 I unleaded asoline i.n <br /> K 'J9--- --- - <br /> ---------------------------- <br /> r �---------------------------- ------- ----- <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> M v <br /> P APPROVED APPROVED WITH CONDITIONS DISAPPROVED <br /> L (SEE ATTACHME WITH COW TIONS) - <br /> A PLAN REVIEWERS NAME <br /> ------------ -- <br /> - -- -- ..... <br /> DATE �_ <br /> N -»------------ --__ _ ------ <br />° APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAOUIN 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: 91 CERTIFY THAT <br /> ' IN THE PERFORMANCE OF THE WORT; FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER, AS TO BECOME <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 WORK FOR WHICH THIS PERMIT l5 ISSUED, I SHALL EMPLOY PERSONS SUBJECT <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br /> SI�iNED ------------- -------------------------------------------------- DATE <br /> OFFTC[ USF QAII' <br /> sissisiisiiism ISI isimiisiisiisiiiiifiiiiifiiiiiisiifiiliiltistititisiiSiiiifi� <br /> SWEEPS I ' CONP I }LOC CODE 'DIST CODE' AMOUNT DUE AMOUIIT RCVD CKIICASH RCVD BY: DATE P.CVO + PERMIT 1 <br /> r - <br />