Laserfiche WebLink
F <br />A <br />C <br />1 <br />L <br />T <br />Y <br />C <br />O <br />M <br />T <br />R <br />A <br />C <br />T <br />0 <br />A <br />I <br />A <br />M <br />K <br />P <br />L <br />A <br />M <br />• ENVIAONI[NTAL NEALTN DIVISION • PPLAICATION FOR (IWIANINIEADYAK CLOSURE PERMIT 339191yEg <br />M <br />MAR 0 5 1992 <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ASANOONIENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY <br />THIS PERMIT EXPIRE$ 90 DAYS FROM THIS APPROVAL DATE. DO NOT WRITS IM ANY SHADED AMU. Iw�y� rAi�lE l <br />REMOVAL — TEMPORARY CLOSURE __ CLOcuK IN PLACPERMIT/SERVICES <br />EPA $I T1 S C4 c C,)Or j S�Z�z PROJECT CONTACT S TELEPHONE / W11-7-- � i,r� 2D9 5z5� <br />FACILITY NAME 14rr- Z,4��ey6E PHONE / ,20 <br />,/ % <br />ADDRESS�7pCe7?lN 37;eE67r5 �oorr� �� 95366 <br />CROSS STREET /� pn <br />OWNER/OPEAATOR <br />CONTRACNAME 5EmG0 <br />CONTRACTOR ADORES! '131 40, <br />INSURER %�f%NS ER/Gfi /7 <br />TIRE DISTRICT LTG/ <br />LABORATORY RAKE Geo A14L`%TIC�J[� <br />SAMPLING FIRM 0Ed �ti/JGyTiG�/L <br />III II VIII 1111111 I�I 1111111 III ------ <br />TANK ID TANK SIZE <br />39- <br />39- <br />39. <br />39- <br />39- <br />39. <br />39 - <br />PLAN REVIEWERS MAZE %l <br />IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br />►N= 0 <br />Z09 599 2�W <br />PHONE / 20y <br />CA LIC I �f(tI�Fl7' CLASfa 3 <br />WORK.COP.0 A*90 SGI <br />Si/ X209 PERMIT ENO% <br />PHONE E <br />PHONE / 2p/0 <br />CHEMICALS STORED ORRREMYLY/PREVIOUSLT DATE UST INSTALLED <br />_ APPROMED NITS CONDITION(!) DISAPPROVED <br />(1tl�TTAC)1)rT WITS CMIT)CNu <br />_ DAT! <br />iurnuraumuuuwunlullululmllmuluanmluuumlul--_ <br />APPLICANT NKAT PERFORM ALL WORK IN ACCORDANCE WIT$ 4tH JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES AND AEGULATIORf OF ..... <br />SAN JOAOUIM COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT01 SIGNATURE CENTIFIES THE FOLLOWING: 01 CERTIFY THAT IN <br />THE PERFORMANCE Of THE YORK FOR WHICH THIS PERMIT IS ISSJED, I SMALL NOT EMPLOY ANY PERSON IM SUCN A MNNMER At 10 BECOE <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S NIRIND OR SUBCONTRACTING SIONATUe CERTIFIES THE FOLLOWING: <br />"I CERTIFY THAT IN THE PERFORMANCE OF THS WOR[ fog WNICN TRI$ PERMIT 11 ISSUED, I SHALL EMPLOY PEASONS SAJECT TO WORKERS <br />COMPENSATION LAYS Of CALIFOUTA.N <br />APPL ICAN III SIOIATLRLEF �""'l �"�,L�� /��/-� <br />TITLE v4lrr L DATE 26 9Z <br />EN 23 046 (Nov 2/(1/91) /t <br />- PR$R 3 <br />