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t: UNDERGROUND TANK t: 1601 E HAZELTON AVE., STOCKTON CA t: <br /> t: CLOSURE OR AB HDONMENT t: Telephone (209) 468-3420 :n <br /> • :2 t}. IN:, :i�:►):1}:1XY]: }:1':��:OXY}:�}:E):��:�}:YY.Y}:1}:Y}:►) �.•Y. <br /> .. r .. .. .. ....r...... <br /> ;APPLICATION FAR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY >r� <br /> �`."7HIS•PERMIT YPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS, INDICATE PERMIT TYPE BELOW: <br /> _ REMOVAL TEMPORARY CLOSURE ____ ABANDONMENT IN PLACE <br /> '`EPA'$ITE 1 PROJECT�CONTACT t TELEPHONE #I <br /> CAC 000543856 <br /> F� :fACIIITY NAME Precissi lying Service PHONE f ( 209) 369-4408 <br /> CIL 'f <br /> .. <br /> ADDRESS - <br /> �Y--/ 11919 N. Lo er Sacramento Road, Lodi , Ca 95242 <br />: �� .:•., .•.. � ''qtr <br /> 'CADSB STREET �• <br /> & Lower Sacramento Road <br /> /OPERATOR John Precissi PHONE I <br /> Peter Precissi ( 209 ) 369-4408 '' <br /> CONTRACTOR IIAME - -------------- -•--w=PHONE.-1=-- --.------ • . <br /> Western Meter Service, Inc. - ( 209 ) 948-6124 <br /> CONTRACTOR-ADDRESS 2735 Teepee Dri Suite E CA LIC I 414051 CLASS C61/13-40 <br /> Lodi, Ga 95205 <br /> y .::• _ <br /> *'INSURER �S. <br /> �, '•� Golden Ea le Insu_ran_ce_ WORK,CONP,1_NWC110296 �t <br /> C� �FIRE;DISTRICT - - �• ---.- <br /> San Joaquin County <br /> PERMIT t/INSPTR <br /> `b L_ <br /> L'ASORATORY•NAME 4PHONE 1 ( . <br /> eRi "3'`:,••., -iP6 � ,-v i r�nmPn z+ 2 0 9 ) ` <br /> Iib FIRM# <br /> • TS Environmental SA LING METHOD Soil excavation by backhoe <br /> 0-1 hU hand with r a s gs`.; <br /> ..�-�,r•1.-'.� TANK iD 1 <br /> TANK SIZE EMICALS1DW0 6r3CUW1a CHEMICALS STORED PREVIOUSL tubi:f <br /> f `F ------------- <br /> - <br /> _ - 10, 000 gallon aviation fuel same <br />•., . 1,FS ------------------ <br /> --------------- <br /> --------------- <br /> - <br /> ------------------------------ <br /> . 1 LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> t 7 <br /> A111M HIM <br /> APPROVED ___APPROVED WITH CONDITIONS ___ DISAPPROVED <br /> — TTACHMENT WITH CONDITIONS) V. <br /> NAME . yC- =�•-J_ ;--------------------------------DATE__ --------------- `i. <br /> s / 1 ►`` <br /> f.• <br /> I T PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE-LAWS, AND RULES AND REGULATIONS ' <br /> �S'JWK'`JOADUIN*LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT <br />..•• <br /> 'PERFORMANCE 0i"'NE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO'BECO <br /> �TO¢YORICER19 COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE # "•j��`` <br /> IN6t�► <br /> CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC •.� . <br /> �•00IS'COMPENSATION LAMS OF CALIFORNIA. <br /> ALL. FOR INSPE51IONS AT LEAST 48 HOURS IN ADVANCE <br /> AZ-k--,e_'63__ <br /> fICf 6Sf: - -__--" DATE 12-20-90 <br /> N[Y741 23 016 11/88 ------- - <br /> Burl DuBose, General Manager ------------------------- - <br /> - ��•, <br /> i>liiifffifffiiffififffffiiffifiifffiififfifffii;fiififffiffffffffffififiifffffifffffffiffffffifffffiffffffffiifffiffff <br /> i COMP i LOC CODE DIST CODE MOUNT-DUE AMOUNTkCVO I CKI/CASH �- RCVD BY LDATE RCVD PERMIT•{ <br />