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12/21/2001 09:25 2094Eb_ 33 FIFTH FLOOP PAGE <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR UKDERCRCUND ST07RAG5 TANK INSTALLATION PERMIT <br />THE APPLICATION PC% 1931ALLATI01 OF UN0L'RGRC4iN9 VORAGE 7ARKS IS t1YLY VALID FOR THE CALENDAR YCAR 141 VNICH IT HAS SEEN ISSUES. <br />A P.RMIT NAY BE EXAK949 INTO THE NW CAI-CNOAR YEAR IF A LETTER 19 SENT TO RNS -EHD R:DUESTING TM(I$ 1;}ITENETON THIRTY GAYS <br />PRIOR TO tNE END OF THE CALENDAR MR, A CNE TIME, OWE TEAR EXTENSION NAY 8E GRANTED 87 0is-E1E6 MH RECEIPT 4F THIS LETTER. <br />00 NOT VRITE IN AMY 514AUEJ AREAS- <br />_ 7�PROJECT MNTACT A TILEPHW �� <br />d <br />FPA 31TE Y i <br />F FAC1LITr X&ME <br />A ADORGss j <br />I <br />L CROSS 91REET <br />t PRONE d1 <br />T 04NLRfOPERATOR�, �� <br />is CONTRACTOR NAME 1 DHdI EZQ� <br />N E191TEACTCR AODJ99SZ:� cA LIC <br />01CLASS <br />R NA2ARIM VASTE CERTI1`110 yes— N9,_ I:ORK.LCMP.3I <br />C FCRE CISTRS07 4 I- '� PERHIT 11 <br />T <br />0 EOARO OF E4UALI2ATIi5N r! <br />R <br />{111111111 i�l��l�ltlllll1111 TANK SIZE CHENICAAL$ Ta a6 97OAfD - - FAOPOSJED INSTALLATION+ <br />DATE � <br />39 _ 7 <br />A S9- <br />* N 39- <br />39- <br />39, <br />IElt � T <br />J L APPROVED Y17H CONDTIION(S.) ` GISAAPRdVED <br />I (S ATTACHMEMT WITH SOMDITIONS) PATE <br />N PLM REVIEWEAS UAWli{111 <br />1!111111{Illlill�lll I!� <br />APALItANT MUST PERFORM All YORK IN ACCo<iDAdGE S)SN OAOIJfJI COUNTY DRCINANCESr STATE LAYS, ANO RULES AMD RDGULATtONS OF <br />SAN JCAOUIM COUNTY PUBLIC HEALTH SERVIGES. CAER OR ACEWIED AMOT'S SIGNATURE CERTIFIES THE FOLLOYING- `T CERTIFY THAT 14 <br />THE PERFOIMANCE Cf THE i10RX FOR 01CH THIS PIRMIT It ISSM , I TCQ SLNUT H[AINCNPLOT ANY DR SUSCCINPRACTINGERSON NSIGNATUR„ANNER AS CERT[FIEbOTHECFULL0111HG,1 <br />CRAL <br />93JECT TO NORXER'S COMPENSATION LAWS DF aALIFORHIA. C <br />"I CERTIFY THAT IN THE PERFOIWANC{ Of THE WORK FaR W CH THI9 PERMIT IS [SSUEO, T SHALL FMPLOY FERSDAE susie CT TO WORKER'S <br />COMPENSATION LAYS OF CALIFORNIA.0' f 4cx* <br />TITLE GATEApPL1cARrFS iIGNATURE: <br />Irdieate the rKpon93b4e party IG bo billed for oddf:lona� pRI-ENO staff t(oa exp"Wed beyond the a hour minimum instelletfar <br />peym m . Tk Darty 8113t &0knewl4d9e chis rtiPOn6ibi;ity fOr vddEtlanal bi[Ilnq !7y signature and Cate below. <br />Tame .-wiz-” <br />tate <br />Slamture <br />EM 23 009 Shvv 12!13193, tdT Rpg'S Mey 5, 1994) <br />4 <br />Z -d OOZE 13CN3SU-1 dH WdSO:ZT T002 BZ 33a <br />