Laserfiche WebLink
MAY-22-96 WED 14:09 K E CURTIS CONST CO INC FAX NO. 5102479592 <br /> ` <br /> MAY-21-9B TUC Q2;p- prl K.E. CURT I S CM I ITE 7 ' 253 2585 x/ <br /> �z APPLICATION rO%._...CRCRQ MV TANK RETROFIT, TANY L19IN9, OR PIFIN• Alit 9fR61IY <br /> �a y <br /> THIS PERMIT EXPIRES 90 DAYS FROK THE APPROW-DATE. 00 TOOT WRITE 1N ANY SHADED AREAS. INDICATE PERMIT TYPE 9ELOue <br /> 'Moo's 40 34 <br /> TANK �l+s TAMK LINING PTPIIIb 4&moi "ce1t3Tc41 d <br /> EPA SITE N Zo 41 o 47 PROJW OCATACT a MCPHONE � <br /> F FACIL177 NAME �t PHONE >Y <br /> A <br /> C ADORESS <br /> 1 <br /> L CROSS STREET Aa fav 4cr." <br /> 1 <br /> T OUNErt(O"Nam PHONE 1 <br /> C CONTRACTOR NAME [r4 a +t [gyp PN6NE 3: U_2`,p�. <br /> 0 t <br /> M CONTRACTOR ADDkE ! CAL LIC or , q ► L a CLASS <br /> f <br /> R INSURER W2K.C1HP,I VC_3 23Z g'3-6 <br /> A <br /> c OTHER IUFORHATlcw ve <br /> T <br /> a PHONE 9 <br /> IZ <br /> PRONE 1 <br /> ss�snuss�nsss�ansssls�isi� <br /> AN); Z0 TANK S1t9 CHEMICALS STTPiEO CURRENTLY R1V7OUSLY DATE Ust INSTALLED <br /> 39• I tr r.P a <br /> jvr,2S C5 <br /> 39- <br /> S&� e^r• rte f g 'S <br /> r <br /> A 30. „1 i - - <br /> [ v 4 - -- -- - <br /> 39- - -- <br /> srss <br /> F,4pL% <br /> APPAL o 11111111111 OMM1111 11WITTITTRI 1111111 <br /> APPR9tEO VIfH CONDITION(l) 0[S"FR(Wo <br /> PLAN REVIEWERS RRME SEE ArTAcr+nExr uITM tOIVflItIDf13) <br /> srsntnllsssstE�t�l�ssrsiilrs�rrrm ��m�mmn �i f �irii �� i s <br /> APPLICANT MUST PERFORM ALL WAX IN ACODRDARCE WITH SAH JOAaOIN COUNTY ORO(HANCES, STATE CRUS, AMD RULGI AMU JIECULATIONS Of <br /> SAN JOAQIITH CCL1NTY PUBLIC HEALTH SERVICES. OWNER OR LICEN9 0 ACERTeS SICHATURE CERTIF10 THE FOLL&JIU41 "i CERTIFY THAT IN <br /> M PWIAMARGE OF THE WORK FOR WHICH THIS PERMIT 15 155UK0, T SHALL NOT EMPLOY ANY PERSON IN SEICH A WWI As to WOME <br /> SUBJECT TO WORKER'S COMPSNSATIOM LAYS OF CALIFORNIA," CONTRACTORS HIRING 04 =CONTRACTING STr,NAT(7RE CEHTIFIEN THE FDLLOUING: <br /> •I CERTIFY THAT 19 TSE PER1Cam4NCE 9F THfi woR!! TOR MACH THIS PERMIT TS ISAUrb, 1 SHALT, EMPLOY PERSONS SURJECT TO UORKERIS <br /> COMPENSATION LATS OP CALIMANTA.m <br /> APPLICANT'S i<IGf4A?UREI ,x;_10 TITLE S " } DATE <br /> AILLIHC (AfORMATION: <br /> Indlaato the respansibla party to be billed for addltlanat PHS-01D staff time exPmdcd bCYO)d permit DavmtAt CWgrage psr tank. If th <br /> Party deligmated Wow Is different than the Nroft iVplicant, e.g_ prnpa-rty owner, the party mAC MCkMwtedse this responsibility fa <br /> the bRt'ing by signature and date beton. <br /> Name �r 15 �o h <br /> Mailing Addresg I sj� G t7 <br />