REMOVAL_1996 - Laserfiche WebLink

Home Browse Search

PUl3L��, Jl L/ ( 1��, 1 1JL��.r'IC ES 1Q: 1� Qr, SAN .IOAQUIN COUNTY Y r.' ?, j ENVIRONMEN'1•AI., 111sAL'f'11 DIVISION t I I;ruesl M. hllploolo, M.D., WPM., Acting flenlf i officer c �; 445 N. Spit .Ionqulft Simi • P. O. I1os .188 • Slocklon, CA 95201-0388 4(Ikddii I i 2119/468-3420 Act!AUA'AO-N 1=UR 1'ISItAIff_'I_O CWSr UNQISIt(;KOUN1 STOItA(;K'1'ANKS 810itIN(; IIALARDOUS MA'flil(IAIS OFNI111AL INS'PRUC11ONS: I I. Subndl nil hnlornnton in frlpllcn,e. Answer nil questions, leaving no blanks. One copy will be relurned Io the npplicnnl wilh conunenls. I J. Iflrinde If Ifelnilcll slle I11np1 fill a Scl/nrate Alice, of polio,sitl)wing file h)cat(1rl of the tanks(s), piping, SInCCIx, aliJarClll pll/plcllle4 (Ill)rtl If)Watd IIIc. h/p If Zile page), nearly SCpte tanks, Icachtlelds,wafer hells, bId111Ingn, Illldcf gt!7111111 pllllllle Iffillfy line-, (Inchllltng water, snnllary sewer and storm sewer), Ioo1 dklatice of piping honl Innk to dlspenscrs. If undergr/und ulllilles are not Included on the site amp, yoo alnsl stale In willing that USA Dig will be contacted prior to excavation activities. I i I I. Complete pnge 1, 'Applir.ntinn for finllergt'mind T"nit Cho-nlre Perri!". I' i 4. Clnnpiele page 9, "Anlhol knitml ro Itelense Annlytcnl limn". This form must be signed and doled !, by file OI'VNr RMI'p:IMMIt of (lie faclllly. i I I 5. SlIIIIII l file apprupllale fees and congdcle page 11,the*Unitergroumd'I'mnk Progrnnl Fee Worksheet". I I f1. Congdcle nil quesfions on page 10, file Public Iiealtl Services-Cnvironnlental lleallh Division I. (I'I IS-GI lU) "llndclgrmnnl Sbrnge 'I'nnk Illsposlllon '1•rncking Record", except those rerhdring a signature rind dale of Innk to novel. 'I lie holder of the pernlll shot[ be responsible for ensuring (het this form Is colopleled and warned Io 17II34L'1I0 within 30 dnys of life look removal. 1 I 7• Suh1n11 If 'Elle Ilennh A Safely I'Inn" ns mf nddendunl in this oppilcnllon, to tiddiess all polenllnl hnrnlds for this specific Joh site. Itcrer to Ihe Site Safety Plan UuWance Document for specifics. I I 8. If Incilily Is located oulslde of Ihe city Iindls, sourest a "Ilncknil ISsenvntlon Cerlllicnre" as required by Ihe Connly of Snn .fongohl Vullding Depmrntent and file Incorporated City Bullding DeparlmentS, I pursulot to the Uniform Buildlog Code S'I'D 711-11. I p I I 9. Obinin n "Grndlmg mid rvcnvnllon I'el'111R" from the City of'r•rncy Building Division prior Io p1-IS- r--1 11) approval or file closute pine. Iff. *1 lie nlaxtltltllll review little for Closure Pions Is 15 winking days from receipt of the adequately I annplelelt pinn. If grass ticllcicncim ore Identncd,on nddendunl will be required with a 578.00/hour fee mId Ihe MOW will begin on Ihe dale of rc,`ubndlhnl, j I 11, Submit vellflumfou of the file penldt from life appropriate Ore district at the removal Inspectlon, I I1. Advance Ins Icctlun ounce of of least 48 hours Is icquhcd by PIIS-C11U Is1I 1.111111 (Revised I i/INz) Page 1 b "C"D AUG 14 1(x'5 €NVIROOENTAL HEALTH PERMIT/SERVICES A IlWlalnn of Sen.Inegnin (:rani, Ilydlh Cert servicer li i� h