Laserfiche WebLink
i , 1 _ro c - .:I � t-;; j(1 '` P. j <br />ENVIAORMINTAL HEALTH DIVISICN <br />APPLICATION FOR UIDERCRLUND STORAGE TAMC CLOSURE PERMIT <br />APPLICATION FOR PE.lAAMEKT/TEMPCRARY CLOSURE OR ASAMOCMMEMT IM PLACE OF UNDERG20LWD 9AZA3WaM SUBSTANCE STCRAG9 TARK <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WITS IN ANY SHADED AREAS. MICATE PERMIT TYPE BELOWI <br />REMOVAL TEMPORARY CIDSURE — CLOSURE IN PLAME <br />0.PPLIf.AHF MUST PERFORM ALL WORK IN ACCORDANCE WITH SAM JOAWIR1 COUNTY ORDINANCES, STATE LAMS. AND ROLES AND REGULATICWS Of <br />SAH :OAOUIU COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AG'ENT'S SIGNATURE CERTIFIES THE PDLLCWING: At CERTIFY THAT IN <br />THE PERFORMANCE OF THE LCRK FOR WUl CH THIS PERMIT IS MMIEO, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH A HUMMER AS TO BECCNE <br />SUBJECT TO 'r.ORKER'S COMPEMSATMU LAWS CF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTIMG SIGNATURE CERTIFIES THE FOLLONINC. <br />-1 aRT1AY THAT IN THE PERFORMANCE OF THE WORK FOR 'J11ICH THIS PERMIT IS ISSUED, I SHALL EMWLOY PERSONS SUBJECT TO SCRKER'S <br />bMDFHYATION LAWS OF CALIFCRNIA.(-I <br />APPLICANT'S SIGNATURE: / :7 TITLEDATE ly <br />y / ano <br />CH as i,:b (Re,ised :/26/94) Page 5 <br />EPA SITE 3 A�A"Tt� �Q ((Qd 3(OO <br />I PRO=ECT CONTACT L TELEPHONE Y y� PITC <br />p 3z - Ji J/O <br />P <br />'/�� <br />FACILITY MANE V A'IA�e/flI/� <br />/ LO % <br />PHONE B <br />A <br />C <br />r <br />ADDRESS <br />I <br />L <br />CRDSS STREET <br />I <br />OI.MER: OPEWTOR fA-uAn' A ��oa�4 <br />PtFDNf <br />X!G ooG� <br />III�YYY3z <br />C <br />! � <br />CMTRACTCR NAME �^r�Eri%lx //�r"��7`*�0 <br />PHONE 0 <br />- /o <br />NCOMTRACTCR <br />ADDRESS �„ G/ (C,✓E.�+C/ /` <br />Gl LICE zo / <br />CLASS A - �jQ� <br />T/ <br />!NEARER ('v /'UZ) <br />HORK,COMP., /,3 g 336 - 9iv <br />C <br />FIRE DISTRICT TGY <br />I PERMIT s <br />D <br />1 LABORATORY KAME <br />PHONE x S/a - 4 `I ?I p <br />R <br />�+� <br />SAMPLING FIRM �ry/1'(� <br />PHONE Y <br />e� p <br />� �L/G LQ <br />11![Illili��1111111111111i1)11 <br />r NK TANK YI25 <br />39_ �4�1-0( add /Ut <br />GAEMIGLS STOR D CURRENTL7/DREYICUSLY D iE LLS i"I 6 <br />�ASTf O.L �lN 1/aw <br />T <br />S9- <br />— <br />A <br />39• <br />N <br />T9 - <br />E <br />39- <br />Illltlif I !! t I1 111 <br />1 tI 11 111111 <br />r ulna <br />P <br />L <br />� APPROVED APP0.0VfED WITH CDMOITTON(S) DISAPP0.0YE0 <br />A <br />N <br />' TSEE AT A <br />PLAN REVIEWERS NAME L L <br />mIEWY VIjN ': �T� <br />�.a� DATE <br />v'+ <br />1a1111111Illlfllfil <br />T hili <br />0.PPLIf.AHF MUST PERFORM ALL WORK IN ACCORDANCE WITH SAM JOAWIR1 COUNTY ORDINANCES, STATE LAMS. AND ROLES AND REGULATICWS Of <br />SAH :OAOUIU COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AG'ENT'S SIGNATURE CERTIFIES THE PDLLCWING: At CERTIFY THAT IN <br />THE PERFORMANCE OF THE LCRK FOR WUl CH THIS PERMIT IS MMIEO, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH A HUMMER AS TO BECCNE <br />SUBJECT TO 'r.ORKER'S COMPEMSATMU LAWS CF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTIMG SIGNATURE CERTIFIES THE FOLLONINC. <br />-1 aRT1AY THAT IN THE PERFORMANCE OF THE WORK FOR 'J11ICH THIS PERMIT IS ISSUED, I SHALL EMWLOY PERSONS SUBJECT TO SCRKER'S <br />bMDFHYATION LAWS OF CALIFCRNIA.(-I <br />APPLICANT'S SIGNATURE: / :7 TITLEDATE ly <br />y / ano <br />CH as i,:b (Re,ised :/26/94) Page 5 <br />