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,. ;-� � �� � � tFitt'tfi•k�#•t�R;tItC#�i�'�I��l�ffi�k�t��t�k��E��t� '��(„ <br />ICA F RMIT Shit JOAQUIN LOCAL HEALiHI <br />" UNDERGROUND T g: I64I E HAZELTON AVE., STOCK Otl CA ; <br />t <br />CLOSURE OR ABANDONMENT Telephone (109) 468-3414 e <br />:>u:RaR).R)R}YaR}:RAr::R)RARa:I:1)R):_i_:h►).RxRfiRa:rrR>:Ra:rsi}c.':►x►): V AO 1 <br />«r a ♦« rr «r r« as s ae s r ;w as rr a • ar as ra «« rwss W0. a as sa Ell@ <br />� <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br />iNIS. PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. <br />NOT WRITE IN ANY SHADED AREAS. INDICATE PEWif <br />i' HEALTH <br />X REMOVAL _ _ TEMPORARY CLOSURE ____ ABANDONMENT IN PLACE <br />„-: EPA SITE I CAC 000217793PROJECT CONTACT & TELEPHONE 0 r1i ke Fowler <br />F FACILITY NAME California Water Service Company PHONE I (209) 464-8311 <br />A <br />N; ADDRESS Station #1, LaFayette Street and Wilson Way, Stockton, CA <br />L "CRM STREET Wilson Way <br />I; <br /># Tx <br />sz i <br />` N <br />,P r <br />T <br />A <br />C. <br />T <br />O <br />` R <br />ONMERJOPERATOR Cal ifornia Water Service <br />Company <br />PHONE t <br />(209) 464-831.1 <br />1602 E. LaFayette Street, <br />Stockton, <br />CA 95205 <br />CONTRACTOR NAMEJim Thorpe Oil, Inc. <br />PHONE 1 <br />(209) 462-4581--- <br />62-4581 --CONTRACTOR <br />CONTRACTORADDRESS 351 N. Beckman Road, <br />Lodi, CA <br />CA LIC 1 495699 <br />CLASS A, Haz. <br />INSURER on file <br />WORK. COMP. D <br />on file <br />FIRE DISTRICT City of Stockton <br />PERMIT 1/INSPTR <br />LABORATORY WE McLaren Environmental <br />Engineering <br />PHONE 11 <br />(916) 638-3696 <br />SAMPLING FIRM* same SAMPLING METHOD Brass tube -see #5 on :Removal P an <br />TANK IO 1 TANK SIZE CHEMICALS STORED CURRENTLYCHEMICALS STORED PREVIOUSL <br />2 500 nleaded gasoline <br />N --------------------------- <br />Kt <br />'-------------------------- <br />F_ <br />S" ------------------------- <br />9- - <br />LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br />P APPROVED , APPROVED WITH CONDITIONS _ bISA ED <br />L f� (SEE ATTAC NT WITH CONDITIONS) - <br />A REVIEWERS NAME �I� _ _ _ -_-.- ________________DATE,___I�e �9_ . , _----- <br />N <br />IC T ST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br />OF THEJOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br />IN T PERFORMANCE OF THE K FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOM <br />ECT TO WORKER'S TION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES TIt - <br />,.; F IMG: '! CERTIFY THAT IN THE PERF CE OF THE YORK FOR MICH THIS PERMIT IS ISSUEDt I. SHALL EMPLOY PERSONS S E <br />x <br />. M. TO,UNTRIS COVENSATION LAYS OF CALIFORNIA, <br />CALL FOR INSPECTIONS AT LEAST 48 HOURS IN ADVANCE <br />$i D _ _ _ ___-Vice-President__- -__ ......... DATE- No_v_enber 16,„_1989 <br />Offiff vis--ENri?_a <br />##fgfffffffffffffff#fffff#ff#i#fff#ffffffff##ftffiSfff#Iffff#fff##f#fRffflNtfgffff#ff#fff#fffffff#ftfitff#ff46#ft8ffiff#f <br />E_ I I CORP I I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CKI/CASH RCVO BY DATE RCVO PERMIT I <br />