Laserfiche WebLink
_SAN JOAQUIN Environmental HeaitWIMVED <br /> — <br /> -COUNTY-MAY 252018 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK INSTALLA�& <br /> ��IZI X11:1 I <br /> THE APPLICATION FOR INSTALLATION OF UNDERGROUND STORAGE TANKS IS ONLY VALID FOR THE CALENDAR YEAR IN WHICH R HAS BEEN <br /> ISSUED. A PERMIT MAY BE EXTENDED INTO THE NEXT CALENDAR YEAR IF A LETTER IS SENT TO EHD REQUESTING THIS EXTENSION THIRTY <br /> DAYS PRIOR TO THE END OF THE CALENDAR YEAR. A ONE TIME,ONE YEAR EXTENSION MAY BE GRANTED BY EHD UPON RECEIPT OF THIS <br /> LETTER. <br /> PROJECT CONTACT: CONTACT PHONE# <br /> Angel Rodriguez 916-373-1165 <br /> FACILITY NAME: FACILITY PHONE# <br /> 7-Eleven#38153 9 2 5 -351 - 7&f C�6 <br /> FACILITY ADDRESS: CROSS STREET: <br /> 121S. Center Street (Lot 1) Stockton, CA 95202 j 'E. Washington Street <br /> OWNER/OPERATOR: PHONE: <br /> 7-Eleven 714-771-5484 <br /> CONTRACTOR NAME: PHONE: <br /> Walton Engineering 916-373-1152 <br /> CONTRACTOR ADDRESS: CA LICENSE# <br /> P.O.Box 1025 West Sacramento CA 95691 617238 <br /> HAZARDOUS WASTE CERTIFICATE: WORKERS COMP# <br /> X YES NO 9113339-2017 <br /> FIRE DISTRICT: PERMIT# <br /> City of Stockton 18-06582 I <br /> TANK ID# TANK SIZE CHEMICAL STORED PROPOSED INSTALL DATE <br /> 1 re ar gasoline eaded fuly 2018 <br /> 2 8 00 g-al, Rremiurdizasoline unleaded My 2018 <br /> 3July 2018 <br /> ❑APPROVED PPROVED WITH CONDITIONS ❑DISAPPROVED <br /> (see attachments) <br /> PLAN REVIEWER'S NAME Qh -i DATE Q ( I <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,RULES AND <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT.OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE <br /> FOLLOWING'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.,I SHALL NOT EMPLOY <br /> ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' <br /> CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING "I CERTIFY THAT IN THE <br /> PERFORMANCE OF THE WORK FORjVVHICH THIS ;ERTIS ISSUED, i SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFOR <br /> Applicants Signature <br /> Title Date S /6 'I L��► <br /> ILJ <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond the 8-hour minimum installation pp L,� a� <br /> payment.The party must acknowledge this responsibility for the additional billing by signature and date below. Uj M <br /> i� i <br /> Name Walton Engineering,Inc. Date 4/9/2018 / o L <br /> Mailing Address P.O. 15ox 1025 West Sacramento CA 95691 <br /> Signature Daytime Phone z <br /> a <br /> Uj LU <br /> 3of8 <br />