Laserfiche WebLink
r <br />nVti:tt:t R: ti: ti.tint: tt'. it: tvR., ati: tirti: ffi .ki:ti�tt:tvl: Milli: <br />APPLICA i N FOR PERMIT t: $IN JOAQUIN LOCAL HEALTH�fSTRICTt: <br />f UNDERGROUND ?INK p 1601 E HIZELTON AWE., STOCKTON CA t: <br />t: CLOSURE OR 111NDOININT t: Telephone (209) 168-3620 t: <br />tit, it: ti: ti.it* it. ti: tir ti; tittt:ti.it: ti.ti., ti: V ti:tt.ttiti:VrtvOrti:L't1it:it,fftnn:tt: <br />APPLICATION FOR PERMANENT/TEMPORIRT CLOSURE OR IBAIDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORIGE FACILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATH. DO NOT TRITE IN 111 SHADED AREAS. INDICATE PERMIT TYPE BELOW: <br />X REMOVAL TEMPORARY CLOSURE ^ ABANDONMENT IN PLACE I I/ G <br />BPI SITE I <br />_ 4 CAC 00239417 _ <br />PROJECT CONTICT I TELEPHONE I Her stngi eerinE <br />916-422-262 <br />F <br />FACILITY NAME i <br />PHONE I <br />A <br />shouse Nurser <br />-1 22 <br />C <br />_ <br />ADDRESS Victor. <br />I <br />8980 E. Hwy12 , Ca, �OE�C q_ 2 <br />L <br />1 <br />CROSS STREET State Hwy 12 <br />T <br />OWNER/OPBRITOR <br />PHONE I <br />I <br />Herbert Preszler _ _ _ <br />209 368-1545_ _ <br />C <br />CONTRACTOR MIME Herbst Engineering, Inc. <br />PHONE 1 (916)422-26228 — <br />0 <br />Y <br />P.O. Box 22504 <br />COY1RICfOR ADDRESS <br />Cl LIC 1 <br />CLASS <br />Sacramento, CA 95822 <br />503266 <br />A <br />I <br />INSURER Maryland Casualty <br />YORK.CoMp.1 33 11 51 <br />1 <br />--- <br />_-- <br />- _ -- <br />C <br />FIRE DISTRICT Mokelumne Fire Dist <br />PERMIT I/INSPTR No permit needed <br />T <br />0 <br />LABORATORY NINE Eureka Laboratories <br />PHONE 1 (916)381-7953 <br />R <br />-- <br />SIMPLING FIRM' SAMPLING METIOD <br />-- IV0.''OIVNWVWIWJNNYVVIVtVIIRIYVINHIVUVINIIIVYIWIY4iVNYVNVI -----------...__..__.. <br />TANK ID 1 TANK SIZE CHEMICALS STORED CURRENTLI CHEMICALS STORED PREVIOUSL <br />I 6,000 gallon Gasoline <br />1 19-��30 -O I <br />It 6,000 gallon Gasoline <br />1 2,000 gallon Gasoline 1AW 2 7 111,b <br />J9_ 550 gallon Waste Oil <br />39 ' Iv : I <br />- — LISA ADDITIONAL TANK INFORMATION AS NEEDED OI SEPARI AI' K <br />VVVtWNV1VZYYVYVVINVYVVIVVYtlWWYYDVOVIIVNYWIVYIIW NIIIYVIIIIiVNVVWIIIIVINIZVUtVNVIIIVAi!OWWIIVVVVOWVVWV9V0rVtlVVVVIIIVIUSVU"IVVVVVVI!IVICIIIVVIWkVJVIVlNIIVL'10tptIIIIIIIVpdV10YVIIVIIRtIVYWVJIIVUIpIIVINYVIVgWi <br />P APPROVED _APPROVED WITH CONDITIONS__DISAPPROVED <br />L B ATTACIIMEY YItH CONDITIONS) G <br />A PLAN REVIEWERS NAME �2 cz-, <br />IYMNRNNdVYNYYVNNVY O�dINVNVNYHYNpYMVWVNVINVVIYdINVVWYVLV�tlYYIYWVWNWNWYNVWNIDYIVVNNVYIRNNu811 <br />APPLICANT MUST PERFORM ILL WORK IN ACCORDINCE WITH SIN JOAQUIN COUNTY ORDINANCES, STATE LAYS, AND RULES IND REGULATIONS <br />OF TER SIN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICEVSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 11 CERTIFY THAT <br />IN THE PERFORMANCE Of THE YORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN SUCH MAYERS 13 TO BECON <br />SUBJECT TO YORKER'S COMPENSATION LIVS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE <br />FOLLOWING: 11 CERTIFY THAT IN THE PERFORMANCE OF Till YORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJBC <br />10 YORKER'S COMPENSITION LABS OF CALIFORNIA. <br />CALL FOR INSPECTIONS AT LEAST 40 FLOURS IN ADVANCE <br />SIGNED <br />-------DATE � 2 -914 <br />OFFI USE ONLY --E11 23 016 12/81 <br />SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSs'SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS <br />STEEPS I I COMP I _I LOC CODE JOIST COD/MOUNT DUE I- AMOUNT RCVD I CKI/CISE I--RCVD BY I —DATE RCVD j PERMIT I <br />J 1 <br />