Laserfiche WebLink
UNDERGROUND TANK 1601 E HAZELTON AVE., CA <br /> t: t; u <br /> CLOSURE 0' ANDONMENT t Telephone (209) 468-34 <br /> t: Diu <br /> .......... :: :;>:;,;:;,:;x;:�::'::':�•::::::.;�:;3:;%;�;>:;x;Y;,:;;::Y:>::,:?: <br /> 1,. <br /> FOR <br /> RY <br /> LOSURE <br /> NT <br /> OUS SUB <br /> NNIS PERMIT EIPIREES190EBAYSEFROMATHECAPPROVALRDAATE. DDOENOTIWRITECINDANYNSHADEDUAREASND �ARINDICATE PERMIT E Awl 198T <br /> Thr <br /> REMOVALTEMPORARY CLOSURE ____ ABANDONMENT IN PLACE ENVIRONMENTAL HEALTH <br /> ---- �rt <br /> ' PERMIT/SERVICES <br /> PROJECT CONTACT 5 TELEPHONE i S �t os� . <br /> r :FACILITY.NAME $� }. <br /> 9/ tr SC�tJeti �cirw. 5y PHONE t <br /> c° ��n�iEss �Y 6 :-.� • � <br /> 'CRbi STREET t a <br /> :OYNER/OPERAiOR Lti/►4 D,i ,,cern,_ 80«r�cv� S JLIC <br /> Tm <br /> NE iPpe- <br /> -COIRRACTDR NAME Nies4• y-. meter Ser i;rRNE i OR A DRESSa73s tw-e- e 02- .Set, t CLASS <br /> � L1/S�aS <br /> erFr � � WORK.COMP.t y <br /> C MIRE DISTRICT <br /> ' 7 PERMIT UINSPTR b <br /> 1 O "LABORATORY NAME CaG. �' Guafi�r- L4. <br /> PHONE t �..g00'SY3-' CYO6� rry• <br /> SAlll!N6'FIRM+ <br /> SAMPLING METHOD <br /> > TANK 10 t TANK SIZE CHEMICALS STORED CURRENTL CHEMICALS STORED PREVIOUSIL .. <br /> ----------------- <br /> �Q31a_�-!-'_l.__ D oa <br /> L[ST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM , <br /> APPROVED APPROVED WITH CONDITIONS DISAPPROVED L}' <br /> PLUI REVIEWERS NAME ' (SE iACHMENT NIT CONDITIONS) <br /> yr. <br /> -- -� —— - LATE <br /> t� <br /> 1� <br /> ---I IT <br /> ICNIT�}A1ST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS <br /> `SA�I"JOAOUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT >3 <br /> {PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECO <br /> T`TO`YORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br /> OtiLOYING; !MRTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJEC <br /> „TO'YORKER'S COMPENSATION LAWS OF CALIFORNIA, ry <br /> `A''- CALL FOR ,INSPECTIONS T L ST 4B HOURS IN ADVANCE <br /> S1fiMED s — DATE <br /> " ,1--'---- --- --- _ <br /> FICE¢YSE OYU'--EY 23 Dl6 II/i8 ----------- --- - - ------------------------ <br /> f fffffiffSfSffffffiffffffffffffffffffffffffffffffffiffffiffffffffffffffffffffffffffifffffffffitfffftffffffffffffffffffff ys <br /> �t LOC CODE IDISI CODEJ AMOUNT DQE AMO T RCVD CKt/CASHLRCVD BY DATE RCVD PERMIT f <br /> K <br /> k� <br /> c <br /> � i, <br />