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tIVVIRONMENTAL HEALTH DIVISION • <br /> APPLICATION FOR UNDERGROUND TANK INSTALLATION PERMIT <br /> APPLICATION FOR INSTALLATION OF UNDERGROUND TANKS ARE ONLY VALID FOR THE CALENDAR YEAR IN WHICH IT HAS BEEN ISSUED. <br /> A PERMIT NAT BE EXTENDED INTO THE NEXT CALENDAR YEAR IF A LETTER IS SENT TO PHS-EHD REQUESTING THIS EXTENSION THIRTY DAYS <br /> PRIOR TO THE END OF THE CALENDAR YEAR. A ONE YEAR -- ONE TIME EXTENSION NAY BE GRANTED BY PNS-END UPON RECEIPT OF THIS LETTER. <br /> 00 NCT WRITE IN ANY SHADED AREAS. <br /> EPA SITE s PROJECT CONTACT L TELEPHONE 9 707-746-6691 John Johnson <br /> F FACILITY HAKE Super Cheaper#104 SNE " Unknown <br /> A <br /> C ADDRESS SW. Corner of Lathrop rd. & Cambridge Dr. <br /> I <br /> L CROSS STREET <br /> T CWNER/®ERATOR PHONE M <br /> T The Customer Co. PO Box 886 Benicia Ca. 94510 707-745-6691 <br /> C CONTRACTOR NAME Calif. Petroleum Equipment Inc. PHONE v 209-276-1881 <br /> 0 <br /> N CONTRACTOR ADDRESS PO Box 9364 Fresno Ca. 93792 G LIG r 432613 CLASS A, B. C61-D40 <br /> T <br /> R HAZARDOUS WASTE CERTIFIED TES X 110_ WORX.COMP.O 1048003-94 <br /> A <br /> C FIRE DISTRICT PERMIT B <br /> T <br /> 0 BOARD OF EQUALIZATION Y The Customer Co. Underground Storage Tank ee# TYHQ44-018591 <br /> R <br /> nuuunnnunnuunnn <br /> TANK ID 1 TANK SIZE CHEMICALS TO BE STORED PROPOSED INSTALLATION <br /> i 39- 20000 gal Unlead Gasoline 11-95ATE <br /> T 39- 20 000 Cal Premium unlead Gasoline 11-9� <br /> A 39- 20 000 nal Supreme un1 .ad Gasoline _ 11-95 <br /> N 39- 12 000 gal 0 esel 11-95 <br /> K 39- 550 nal waist Oil 1 — <br /> 39- <br /> 39- <br /> 11111rr I I r r r t III rI r <br /> D <br /> L _ APPROVED APPROVED 4ITN COUITION(S) _ DISAPPROVED <br /> A ( 4 ATTAFCtHtMEENNTTTTWIITH CONDITIONS) a� <br /> N PLAN REVIEWERS XAME-Ay11111��11 IILIIII Kt isF GATE <br /> Irrurrlrrlrrrrrrrlr rrur <br /> APPLICANT HIST PERFORM ALL UONK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br /> SAN jCADJIN COUNTY PUBLIC HEALTH SERVICES- OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br /> SUBJECT TO WORKER'S COMPENSATION LAWS Of CALIFORNIA.- CONTRACTOR'S MIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> el CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LADS OF CALIFORNIA.-A'.OR( <br /> APPLICANT'S SIGNATURE: / Vi�� //��.�C�/// TITLE Contractor DATE 09-28-95 <br /> Bryce uschhau t President of'Calif. Petroleum Equipment Inc. <br /> Indicate the respo ibLe perry to be billed for additional PHS-END staff tix expended beyond the 8 hour minimus irataLLation payrsent. <br /> The parry ant acknowledge this responsibility for the additional bi Lling by sigtature and date below. <br /> %a California Petroleum Equipment Inc <br /> Mai l Ing Addrass PO Box 9364 Fresno Ca. 93792 <br /> Day Phone Muber 209-276-1881 Fax 209-276-1894 <br /> Si9roture <br /> Date 09-28-95 <br /> Bryce Ruschhaupt <br /> EH 23 008 (Rev 1/7/92) WP <br />