Laserfiche WebLink
NOV-07-1994 15:15 FROM GEOLOGICAL TECHNICS TO 4640130 P.04 <br /> EMIROIMENTAL M At" DIvISIOT <br /> APPLICATION FOR MERM04) STORAGE TANK LT,CHIUtE PEINIIT <br /> APPLICATION FOR PERMANINT/TENPORARY CLOS RE CR ABA1ppMN Ay 11 PLACE OF UlmER6RM= HATARDOUS SUBSTANCE STORAGE IANC <br /> THIS P"MIT EXPIRES 90 DAYS FROM THE APPROVAL NATE. DO NOT WRITE IN ANY SNADO AREAS. IRDICA PEAMI7 TYPE BEA M: <br /> n REMOVAL _ TEMPORARY CLOWU _ CLOSIRE IM PLACE <br /> FPA SITE ! Gr �I q PMECT CMYACT d TELEPNWE ! Mia �a q� I <br /> V F .Y� i-`rl�JrL 7� <br /> F FACILITY NAME PNOME ! <br /> C ADDRESS i1a845 GAwwtt; QLD <br /> I 1 <br /> L CROSS STREET <br /> j T I OfMEAMPERATOR j Pow !. _ <br /> i I ! <br /> ! a + CONTRACTOR NAME O L—'C 1reMa 4 Sy sM PHONE s �al 2Ln— 7 7 <br /> I = COHTAAQOR ADDRESS Z af'ia A�/C« (k cA LIC R G573b(v �'"�"J� I I <br /> A I IMRER Sa0{{S�Q��r N <br /> ww.CaMP,r <br /> C I FIRE DISTRICT 5%.S Y1� s`, e I -p PERMIT ! <br /> 0 LABORATORY N <br /> A iF6RµrjpD Lie PN NE <br /> AME a Zel -(a(v7- SZ58 <br /> SAMPLING FIRM -P.0-L rGc.�L �i•ac'f. ..ti.wF SK + - PHONE s — — <br /> 11ni11i[IIIIi1lrlrrltllltttfr <br /> TANK 10 N TANK SM CHEMICALS STORED CURREKTLT REVT DATE OST tUVALLED <br /> T 39_ r 1�anb G yam l.nti I <br /> N 39- <br /> S 39- i <br /> 39- <br /> i P }iiir uu 1tni1 <br /> APPROVED APPRMW YM COVITION(S) DISAPPROVED <br /> R PLAN REYIE51ER5 NAHE ` _E ATTACAI[MT WIT% CONDITIONS) <br /> DATE — <br /> 11111111111111111111 1r[N <br /> APPLICANT DUST PERFM ALL WRC IN ACCOFSANCE VITA $RN JORCLIIM COUNTY ONOINANCES, STATE LAWS, AND ROLES AND REGULATIONS OF <br /> SAN JOADWIM CCIIMTY PONLIC HEALTH SERVICES- OWNER OR LICENSED AGENT'S SIGNATURE CFCTIFIES INE FOLLOWING: •I CERTIFY THAT IN <br /> TRE PERFORMANCE OF THE WORK FOR WHICH TRIS P MMIT IS ISSN®, I SHALL NOT EMPLOY MY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAMS OF 17RIFORNIA." CONTRACTOR-S MIRING OR SURCONTRAOTIN6 SISNATIME CERTIFIES THE FOLLOWING: <br /> -1 CERTIFT THAT IN IN FORMAMCE OF THE MARK FOR WHICH THIS PRAMIT IS IS$UGO, 1 SRALL EMPLOY PERSONS SUBJECT TO UMCER'S <br /> COMPENSA7TON LAIR OF LACI i{ NIA.• 1 p <br /> APPLICANT'S SIwnnF_ ` TITLE 8-4v j%- GATE 1� l <br /> i <br /> 0121 <br /> EN 23 OLb C (Hr+/iacd 4/26/9AI /(/ Paw /1/d'6 6��'�%"� � <br />