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INSTALL_1999
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231300
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INSTALL_1999
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Entry Properties
Last modified
5/31/2019 11:50:48 AM
Creation date
11/7/2018 11:13:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
1999
RECORD_ID
PR0231300
PE
2361
FACILITY_ID
FA0001858
FACILITY_NAME
MY MINI MART
STREET_NUMBER
1756
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
11721005
CURRENT_STATUS
01
SITE_LOCATION
1756 N WILSON WAY
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\W\WILSON\1756\PR0231300\1999 INSTALL .PDF
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EHD - Public
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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APPLICATION FOR UNDERGROUND STORAGE TANK INSTALLATION PERMIT <br /> 'HE APPLICATION FOR INSTALLATION OF UNDERGROUND STORAGE TANKS IS ONLY VALID FOR rHE CALENDAR YEAR LN WHICH IT HAS 3E;N ISSUED. <br /> A PERMIT ,MAY 3E EXTENDED INTO THE ,NEXT CALENDAR YEAR IF A LETTER IS SENT TO PHS-EHO .REQUESTING THIS EXTENSION THIRTY DAYS <br /> PRIOR TO THE END OF THE CALENDAR YEAR. A ONE TIME, ONE YEAR E"�(TEHSION MAY SE GRANTED BY PRS-z-HD UPON RECEIPT OF THIS LETTER. <br /> 00 NOT WRITE IN ANY SHADED AREAS. <br /> CPA SITE PROJECT CONTACT 3 TELEPHONE <br /> FACILITY NAME My Mani Mart PHONE (209) 941-2264 <br /> I <br /> C I AOORESS 756 N. Wilson Way, Stockton, CA 95202 <br /> I ' <br /> ` czoss STREET College Avenue - <br /> T i OWNER/OPERATOR Annette Hoag PHONE (209) 474-7532 <br /> I Y f <br /> CONTRACTOR NAME SEMCfl PHEINE (209) 524-9653 <br /> N ; CONTRACTOR ADDRESS 1217 South 7th street I CA LIC 449864 i "LASS A, B, C, C61/t4O <br /> TWCRK.CCMP.;046-0007108-99 <br /> R � :1AZAROCUS WASTE CERTIFIED YES rY VO <br /> A ` <br /> C h� F?RE DISTRICT City of Stockton I PERM 17 <br /> 0 ! 30ARD OF EQUALIZATION w 1 <br /> R f <br /> I 11111111111111I111�l1111111111 , C � I I <br /> TANK '0 r TANK ANK 31,7E CHEMICALS TO 3E STORED PROPOSED INSTALLATIONI <br /> 1 39- 002 9,000-- i Gasoline 5/24 DATE I <br /> T 39- nOl -4 4M--1 Ga.ruo I i ne I r <br /> A 39- <br /> I N9�K , I <br /> '9- <br /> 1111 f � <br /> 1 APPROVED APPROVED WITH CONOITICN(5) DISAPPROVED <br /> A ATTa HMEHT WITH CONDITIONS) <br /> N ?LAN REVIE'.ERS NAME -f _ j'/L DATE / <br /> illllll111111111111111 Illllilllllll 1 11 111111 ! ilillllillillll111111illllllill[llllilllllllllillllllllllitlllllllllllll <br /> APPL;CANT MUST PERFORM ALL WCRK IN ACCORDANCE WITH SAN 40AGUIN COUNTY ORDINANCESS, STATE -1u5, AND RULES AND REGULATIONS OF <br /> SAN .OAOUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLCIING: Of CERTIFY THAT IN <br /> I THE PERFORMANCE OF THE 'WORK FOR 'WHICH THIS PERMIT IS ISSUED, I SHALL HOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO 3ECCME <br /> E SUBJECT TO 'WCRKER'S COMPENSATION LAMS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUSCCNTRACTING SIGNATURE CERTIFIES THE FOLLV41NG: <br /> "! CERTIFY THAT IN THE PERFORMANCE OF THE `WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT 70 WCRKER'S <br /> COMPENSATION LAWS OF CALL ie ` I <br /> APPLICANT'S SIGNATURE: � � �/ TITLE Agent for Owner DATE 5/12/99 <br /> Indicate rhe responsible parry :o be billed 'or addiciona( PHS-EHD scarf :ime expended beyond :he 8 hour -minimum instaLLation <br /> payment. The party .-must acknowledge this responsibility for :4e additionaL biLLing by signature and :ate below. <br /> Name SEMCO <br /> Mai l;ng Address 1217 South 7th Street, Modesto, CA 95351-9401 <br /> lay ?hone Number (209) 524-9653 <br /> Signature Sate 5/12/99 <br /> EH 23 008 CRev 12/13/95, UST Reg'S May 5, 1994) <br /> 4 <br />
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