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9255517888 Line 1 14:49:39 07-13-2015 2/2 <br />0 10 <br />RECEIVED <br />ENVIRONMENTAL HEALTH DEPARTMENI'IL 111015 <br />SAN JOAQUIN COUNTY ENW► <br />, fi a _ Stockton, t 1 �,. <br />Telephone: (20 9) I <br />THIS PERMIT EXPIRES 100 DAYS FROM THE APPROVAL DATE INDICATE PERMIT TYPE BELOW. <br />A <br />EPA site # Project Gantact Telephone # Liddy MGKen21L' (925.559.7555) <br />cFacility <br />NKAISER HOSPITAL MANTECA Phone # <br />L <br />Address 1777 W. YOSEMITE AVE <br />I <br />T <br />Cross Street <br />Y <br />Owner/OPOrator KAISER MEDICAL GROUP <br />Phone # <br />Oc <br />Contractor NameGetkler-Ryan Inc <br />Phone # (925) $51_7555 <br />T <br />GOntmctorAddress 8905 SIERRA CT, SUITE G. DUBLIN. CA945M CA Lfc # 220793 Ctas&os acaxota,Wzrec <br />cinsurer <br />State Com nation Ins Fund wont comp # 9051229-3 <br />T <br />IGC Technician's Name CHRIS SAN NICOLAS Expiration Date 03/17/2097 <br />R <br />ICC Installer's Name Expiration Date <br />Tank system work area Tank Size Chemicals Stored Currently <br />0.. Br OOV amp 91 halt daftcW, LSC 1r4 My y <br />Date LIST <br />Installed <br />T <br />A <br />N <br />K <br />P <br />U Approved Proved with C.Ondltkmrs Disapproved <br />L <br />A <br />(S)e Attd rent With Conditions) <br />N <br />Pian Reviewers Name ® ®� <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, ANDAULES AND REGULATIONS OF SAN, <br />JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENTS SIGNATURE CERTIFIES THE FOLLOWING N CERTIFY THAT W <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT Is issuED, I $HALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SMELT <br />TO WORKER'S COMPENSATION LAWS OF CAUFORNiA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: 9 CERTIFY <br />THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THfs PERMIT IS ISSUED, f SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATE LAWS <br />OF CALIFORNIA." Ar <br />nslaro y mala A ENT EM OWNER DdM <br />j 19 015 <br />BILLING INFORMATION: <br />indicate the responsible party to be billed for additional EHD stats tine expended beyond permit payment coverage per tank if <br />the party designated below Is different than the permit applicant, e_9. property Owner, the party must acknowledge this <br />responsibility for the billing by signature and date below. <br />N,mEMERLIN BOWEN 'niProject Manager NOK #g25.559.7555 <br />1 <br />