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ENVIRONMENYAL HEALTH DIVISION < <br /> APPLICATION FOR UNDERGROUND TANK CLOSURE PERMIT �� +' � +d , <br /> EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT TRITE IN ANY SHADED AREAS. INDICgAwcPERInu''(rn�-/SER HEALTH <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGRONND HAZARDOUS SUBSTANCE Nj FACILITY <br /> THIS PERMIT EN PERMIT/SERVICES <br /> XX REMOVAL — TEMPORARY CLOSURE ABANDONMENT IN PLACE <br /> Martin Thorpe (209) 462-4581 or <br /> EPA SITE B CAC 000614264 PROJECT CONTACT 9 TELEPHONE / _ <br /> illac, GMC, Inc. <br /> F FACILITY NAME Curtiss Pontiac, Cad <br /> PHONE R (209) 835-7750 <br /> A <br /> c ADDRESS 2450 Toste Road, Tracy, CA <br /> i <br /> L CROSS STREET Hwy 205 . <br /> I PHONE B (209) 835-4476 <br /> T, OWNER/OPERATOR Joe TOste <br /> Y - <br /> PHONE B 2001'A6S-6175 <br /> C CONTRACTOR NAME Jim Thor2e Oil Inc. ./ D.B.A. Rich-Mart Const. <br /> 0 1 N. Beckman Rd CA LIC A4 56 CLASS A B Naz. <br /> N CONTRACTOR ADDRESS Po Bx. 357 Lodi Cal. 95241-035 <br /> 1 WORK•CCHP•B 1095135-90 <br /> R INSURER Fir•emans Fund / Admiral _. <br /> A PERMIT B Fire permit will be <br /> C FIRE DISTRICT San Joaquin County d ,,,,,,fir <br /> I PNONE (209) 983-1340 <br /> 0 LABORATORY NAME Weston Analytical - <br /> R PHONE R same as above <br /> SAWLIRO FIRM same a5 above <br />+. TANK <br /> !i Ilii 1111111111111 TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED <br /> 79 1 000 gal Re ular asoline leaded 1970s <br /> r 3v- �� Unleaded reg. gasoline 1970s <br /> A <br /> 39- sd _ p 1 000 gal Os <br /> 1 ,000 al Prem. unleaded gasol7ne <br /> K 79- <br /> )9- <br /> 79- <br /> { P IIIIIIIIIIIIIIIIIIIIIIIIII1111IIIIIIIIIIIIilllllllllllllllllilllll111111111111111illlllllllllllllllllllllllillllllllllllll <br /> APPROVED __ APPROVED WITH CONDITION(S) _ DISAPPROVED <br /> A (SEE ATTACHMENT N N CONDITIONS)) <br /> N PUN REVIEWERS NAME (/v .r —_IS_cr :DATE <br /> IIIIIIIIIIIIiIIIIIIIIIIIIIIIIlIIIIIIIIIIIIIIIIIIIIIIitiIIIIIIIIIitIitIIIIIIIk11111111II1IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN J1310UIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN JOAOUIN COUNTY PUBLIC HEALYN SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "1 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 CER71FIES 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 CALIFORNIA." <br /> rn tr t DATE 7/18/91 <br /> - <br /> APPLICANT'S SIGNATURE: FaI TITLE nr <br /> 1 <br /> j EH 23 066 (Rev 2/8/91) It Page - <br /> a <br />