Laserfiche WebLink
2-13-1996 1:39PM FROM FILLNER CONST INC 916 372 6984 P-2 <br />MIRO MNTAL HEALTH DIVISION <br />TANK C E PERMIT <br />APPLICATION FOR UNaERGRWNf% S SiiB'STma STORAGE TANK <br />ApRtLCATION FOR PEBIMAtffHTITE PpRARY CL=RE OR iSSANOC104EKT In PLACE OF W*r;RGRi ���� <br />THIS TIOPERMIT R p RES 9a /TEMDAYS FROM THE APPROVAL DATE- 00 NOT WRITE IN ANY SNAOE ACLOSURE REAS <br />PL�AICSEATE PERM I7 TYPE BELOW: <br />X REMOVAL _ __ TEMPORARY CLOSURE <br />PkOJECT CONTACT B TELEPOONE 9 <br />SPA SITE 'TLHLOoc j7Bo �C} PHONE= # 2o4- 333- 1!0 3o 0 <br />FACILITY XAKEe"'w/'e&.0 IFa rr�.r/• �{rd <br />6 ADURE4f"v ek fJ! <br />L CROSS STREET 0cr-Fo grS,T j j } PHONE $�/ <br />T OWNER/O OPERATOR � �j o u � R7 [ [ ° e G - <br />Y r" y -7 �j¢ SEE #11 72-- 101 r,� q <br />C CQNTRACTOR MM99 (,( f'►f ~ Gey N � CA LIC #3 t ,�! Z 2fi CLASS cm boo, A, <br />N CONTRACTOR AT <br />?DRESS <br />$ INSUMP 4! fC� • PERMIT 0 <br />C I FIRE OTSTRICT t+�0/i py+ PHONE f �1 32-7-15710IS� a <br />C LABORATORY NAME -g)001A AA-Vt� r � p' i PHCHIE # �! � - 2 i <br />R SAf4PLING FIRM /O cii- ub wi <br />1!1llillllillltill11i1lillllll THEMICAL STORE WENTLvt -T DATE �Y TALLEo <br />ANX SIZE C <br />TASK!O 0 Su F4�°e • �! <br />�a at <br />39- l dp p t` m 't <br />T 39• <br />A 39- <br />N 39- <br />K 39" <br />39- <br />�- !! it t1! 1!! <br />f! <br />P Illi! ! !! 1 11 11 WtTa tcltTaomats� DISAPPROVED <br />L APPRWti? APPROVED ATTACHMENT WITH CONDITIONS) DATE <br />A / !!1!1 <br />g PLAN REVIEWERS MAKE <br />lllitilllllil11ii111 Alai <br />APPLICANT KIST PERFORM ALL WORK IN ACCORDANCE ETTHOSAN ft Lim INACOWTY OSI a ]FR HE FOLLOS STATE LAWS, AND SUCH WING- <br />NNA}iit£RYA tBECOMEOFFY THAT IR <br />SAN jOAGUIN CWmrY PUBLIC HEAL I SHALL NOT EMPLOY <br />Gz <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS LDS RACTING ^�LG21ATliRE CERTIFIES THE FOLLYN <br />SUBJECT TO WORKER'S aIMP¢ISATI(X LAWS OF CALIFORNIA.tO CONTRACTOR'S HIRING OR , I SHALL EMPLOY <br />PERSONS SUBJECT TO uORKIRR'S <br />101 CERTIFY THAT IN THE pERFOmUCE OF THE SII FOR LRICK TRIS PERMIT f5 iSSLIF.D, <br />COMPENSAT1ON LAWS OF CALIFORNIA,,"rTTLE <br />'131 /ef�19 DATE <br />APPLICANT,$ SIGNATURE.. (�l <br />Page 3 <br />E'E 23 046 {Revised 4/26(94) <br />