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f fttt'N,1=:0:tt'tt'tt'tvt1t t17tt'tt tvti,N't4'ftff ff ff ff ki:ft W.V:'z t;'tvfttj t;' <br /> APP 1I0Y FOR PERMIT SAN JOIQUIN LOCAL NEI DISTIICTI: <br /> t: U DERCROUND TANK t, HO I I NLtRLTON IVB., STOCK?01 CAt <br /> t: CLOSURE OR IIINDOYNEIT t: Telephone (209) 168-3120 t <br /> t'tt'tt R,ft tt R tt ti,tt RI k%7 ti It tt,tt tt tt tt tt tt tt,tt ff R:tt:ti:tt:tt N R:ft tt <br /> IPPLICITION FOR PERMANENT/TEMPORIRT CLOSURI OR IBAIDOMMENT IM PLACE OF UNDERGROUND RIZIRDOUS SUBSTANCES STORIGE FICILITY <br /> THIS PERMIT EIPIRES 90 DIPS FROM THE 1PPROV/L DITB. DO NOT I11T1 IY 111 SHADID IREIS. INDICATE PERMIT TYPE )BLOW: <br /> -y- REMOVAL TEMPORARY CLOSURE — IBIWDONMENT IN PL10E <br /> EPA SITE I CAC00196613 ! PROJECT COYTICT i TELEPHONE 1 Erik Friedrich (Weston) <br /> F FACILITY NAME NONE -1- PHONE I 209-476-1635 <br /> I <br /> C IDDRESS 48 N. Wilson Way, Stockton, Ca. <br /> 1 <br /> L CROSS STREIT Weber <br /> 1 <br /> T OWNER/OPERITOP Raymond Rishwain D.D.S . PHONE 1 209-466-0478 <br /> Y <br /> C CONTRICTOR NIKE Decon Environmental Services PHONE 1 415-732-6444 <br /> 0 <br /> 1 CONTRACTOR ADDRESS 26102 Eden Landing Road, #4 CA LIC 1 545726 CLISS A <br /> ? _.. Hayward, Ca - 94545 <br /> R INSUREPPlanet- Gen. Liab. & Pollution LiaVORK.COMP.1 C25811975 <br /> I __-- Si qn;a^wnskmaxL_s rnmn - — <br /> C FIRE DISTRICT PERMIT I/INSPTR <br /> T <br /> 0 LABORITORY MIME Roy F. Weston, Inc. PHONE 1 209-476-1635 <br /> R SAMPLING FIRM' Roy F. Weston, Inc. SAMPLING KETIOD8015 , 8015mod, 8020 <br /> WW:J�IIWilIiWIIIiIWIGIUWl;lplilWK"' �uNV':6NIWIW2YW6i'tF -- SW-846 , D H <br /> TANK ID I TIKK SITE CHEMICILS STORED CURRENTLI CHEMICALS STORED PREVIOUSL <br /> ? last known- <br /> 39------- <br /> nown- <br /> 39------_— _-- r less thaxl LU_Q c� _ Zone– empty_. YCLSOttile <br /> _ <br /> K <br /> I <br /> -- , — — LIST ADDITIONAL 16NK IMFORNITIOK AS NEEDED 01 SEPARITB FORM <br /> 'NIU✓t"�llIIINtlI'IWCIIIIIUIgU'4diNlIUWWBIW000NtiIIWfGlpol�li}IIW!tll '!IW'lll4ii!Ct11'�,!i�IJIIIIIIIiJiIP�L".{tlINIIPli;!IINfi!If!1111�WC6'ti�ICY�V•.!7i3iJ!:iIN11�h9J7°iil;lll,:'illi+I�iF�1191Uih1111�;;1L'olNi!9L'tiWJWiUllil'J1UGW!LilWIIYIIdIICWiu711JIW9LIW'lltlt'11WNL";;9 <br /> P -__ APPROVED —APPROVED WITH CONDITIONS _ DISAPPROVED <br /> 7 !� <br /> L (SEB ITTICHMENT WITH COHDITIOWS — b <br /> I PLIN REVIEWERS MIME DITE <br /> r <br /> UtI�NINf<YYf�W�kH{II'J�'IUYWW'"uuux '""�.';a:'t'-""'m„wc?!�n!r nkn an+��•ma�4nuw;um+w'�"n �"–�—'°,�"�YN6'fd�!�Gd''!idI1�G 'JI,'1[�KlfFilil9lWWiIII�ltitlPJIYW1fi{HIS' RBIt11WWNN{I�YI�111�11M5�!`UINBYhUU9Vi�l' <br /> APPLICANT MUST PERFORM ILL WORK IN ACCORDINCE WITH SIN JOIQUIN COUNTY ORDINANCES, STATE LIPS, AND RULES IND REGULITIONS <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT <br /> IN TER PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH MIWhER IS TO BECOM <br /> SUBJECT TO YORKER'S COMPBISITION LIWS OF CALIFORWILI CONTRICTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES ?HE <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMINCE OF 1119 YORK FOR WHICH ?HIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJEC <br /> TO YORKER'S COMPENSATION LIWS OF CILIFORYII. <br /> CALL FOR INSPE TIONS �,T LEAST 48 IIOURS IN ADVANCE pp <br /> SIGNED_ ` <br /> OFFICE USB ONI B11 23 016 12/ <br /> SSSSSSS$SS$SSSSSSSSSSSS$SSSSSSSSSSSSSSSSS$SSSSSSSSSSSSSSSS$SSSSSSSS$SSSSSSSSSSSSSS$SSSSSSSSSSSSSSSS$SSSSSSSSSSSSSSSSS$SSS <br /> SYBEPS 1 ( COMP ILOC-CODE I DIST CODE' INOUNT DUH I• AMOUNT^RCVD-- j,. CKI/CASH <br /> - I---RC4D-BT- � DATBYRCVD- I-- PERNII ( <br />