COMPLIANCE INFO_1996-2004 - Laserfiche WebLink

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F A C I L I T Y C 0 N T R A MAY 2 81996 ENVIRONMENTAL ENVIRONMENTAL HEALTH DIVISION i -� � PF�R�/fiT / SERUIC�_�.�� APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERM] APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND DOUS SUBSTANCE STORAGE TANK THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED A A INDICATE PERMIT TYPE BELOW: REMOVAL TEMPORARY CLOSURE CLO RE IN PLACE EPA SITE #GAL a►3(DO to33(o3 PROJECT CONTACT & TELEPHONE # UO2LA\ �1 SO --S- 3,24-:7 FACILITYNAMEVrMr.-,-,� -- _(�-r PHONE 1� 4-n_31(� ADDRESS 12lE, 0A CROSS STREET A -i -O L-jei OWNER/OPERATOR nn u�k m A f2 CONTRACTOR NAME WA��C` CONTRACTOR CONTRACTOR ADDRESS INSURER t' � ®0-r F RE DISTRICT ABORATORY NAME I, v -e-_- , , SAMPLING FIRM tJOE� VV 111111111111111111111 111111111 FIs P / L A PHONE # �E PHONE 19l� 04 CAL CA LIC # (o1 -7 9 A g CLASS A 11 _ (-�PiZ• �MWORK.COMP.# VJ�JCJCJ__1o5 �� rY PERMIT # PHONE p (Q1 PHONE ANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED D lc IV�I.t'71i7 �i�-CDU ✓I � 1"ig® ao ULp LZAD ✓1 t u vt t 09 o I,AScu ✓i t 1 ill IIy"m I In 111 11 1111111111111111111111111111111Inli II 11111111111111111111, VEDAPPROVED WITH CONDITION(S) DISAPPROVED ( E ,ATTACHMENT WITH CONDITIONS) / N PLAN REVIEWERS NAME DATE - L3 11111111111111111111 I I I I I APPLICANT MUST PERFORM ALL;ALTH IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WO0 FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMP SATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE RFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OFC IFORNIA." 2 APPLICANT'S SIGNAT TITLE �l4 DATE—Z �.,_ ��wu�s cJ'� {� �;.�t�-� (i•�J /1GJz.Gt.�z� G�..� . EH 23 046 Tvis 4/86)/94) ( j I -7,% Pa 3 1 _ - �r6p. r,ee�fi l -% •. Ce k dui rt R.Gt r,� -� �e� r�` L�� z ( i�-$ ll�- , �, + �° ' �`f S �. TANK ID # II Z l T 39-:1:& 11 2 SoZ A 39- iZSD3 N 39- S/4 112-50 zk- K 39- 39 - FIs P / L A PHONE # �E PHONE 19l� 04 CAL CA LIC # (o1 -7 9 A g CLASS A 11 _ (-�PiZ• �MWORK.COMP.# VJ�JCJCJ__1o5 �� rY PERMIT # PHONE p (Q1 PHONE ANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY DATE UST INSTALLED D lc IV�I.t'71i7 �i�-CDU ✓I � 1"ig® ao ULp LZAD ✓1 t u vt t 09 o I,AScu ✓i t 1 ill IIy"m I In 111 11 1111111111111111111111111111111Inli II 11111111111111111111, VEDAPPROVED WITH CONDITION(S) DISAPPROVED ( E ,ATTACHMENT WITH CONDITIONS) / N PLAN REVIEWERS NAME DATE - L3 11111111111111111111 I I I I I APPLICANT MUST PERFORM ALL;ALTH IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WO0 FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMP SATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE RFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OFC IFORNIA." 2 APPLICANT'S SIGNAT TITLE �l4 DATE—Z �.,_ ��wu�s cJ'� {� �;.�t�-� (i•�J /1GJz.Gt.�z� G�..� . EH 23 046 Tvis 4/86)/94) ( j I -7,% Pa 3 1 _ - �r6p. r,ee�fi l -% •. Ce k dui rt R.Gt r,� -� �e� r�` L�� z ( i�-$ ll�- , �, + �° ' �`f S �.