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<br /> TAIT & ASSOCIATES INC.
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<br /> SACRAMENTO GENERAL
<br /> 2880 SUNRISE BLVD., STE. 208 918-835-2444
<br /> RANCHO CORDOVA, CA 95742 �""'"" ""e":✓� w° `�•`+Y "' .k w
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<br /> ORDER OF_— C'A_
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<br /> iHl$CN4GK IS DELIVERED Fop t',Y LNT pN THE ACCOUNTS Ld9TE0 - ' ..
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<br /> A WORK.COMP.
<br /> C" C OTHER INFORMATION
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<br /> TANK ID 9 TANK SIZE
<br /> 39 � CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED
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<br /> A 39 12 000 AL 2 LITJ�enn AyOW
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<br /> K 39-
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<br /> A APPROVED APPROVED WITH CONDITION{S}
<br /> N PLAN REVIEWERS NAME
<br /> (SEE ATTACHMENT WITH CONDITIONS) DISAPPROVED
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<br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOACUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF
<br /> SAN PERFORM
<br /> N COUNTY PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING;
<br /> THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOM"AT IN
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<br /> SUBJECT Tfl WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIESTTHE FOLLOWING:
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<br /> "1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT TO WORKER'S
<br /> COMPENSATION LAWS OF CALIFORNIA."
<br /> APPLICANT'S SIGNATURE:
<br /> TITLE DATE
<br /> BILLING INFORMATION:
<br /> Indicate the responsible party to be bitted for additional PHS-EHD staff time expended beyond permita
<br /> party designated below is different than the permit applicant, e.g• property owner, the party must acknowledge this responsibility for
<br /> the billing by signature and date below. P yment coverage per tank. If the
<br /> Name U d C4 L Ccs
<br /> Mailing Address 7G, oM
<br /> Day Phone Number (_qjl�v g583I -. -r� f
<br /> Signature .
<br /> EH 23-0038 PA MEN T
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<br /> MAY 1 7
<br /> IAN JOAQUIN CD INTY
<br /> PUE30C HEALTH St-r,,,,.I.
<br /> ENVIRONMENTAL HEAL f�;
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