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FAC. 548 <br />r ; %ViRONMENTAL HEALTH DIVISi* <br />r <br />APPLICATION FOR UNDERGROUND TANK INSTALLATION PERMIT <br />C APPLitAT10N FOR INSTALLATION OF UNDERGROUND TANKS ARE ONLY VALiD FOR THE CALENDAR YEAR IN WHICH IT HAS BEEN ISSUED. <br />A PERMIT MAY Be EXTENDED INTO THE NEXT CALENDAR YEAR IF A LETTER iS SENT TO PHS-EHD REQUESTING THiS EXTENSION THIRTY DAYS <br />PRiOR TO THE END OF TiLE CALENDAR YEAR. A ONE YEAR -- ONE TiME EXTENSION MAY BE GRANTED BY PHS -END UPON RECEIPT OF THIS LETTER. <br />DO NOT WRITE iN ANY SHADED AREAS. <br />indicate the responsible party to be billed for additional PHS -EMD staff time expended beyond the 8 hour minimum installation payment. <br />The party must acknowledge this responsibility for the additional billing by signature and date below. <br />Name Tait & Associates <br />Hailing Address 1001 Galaxy Way, Ste. 404 Concord CA 94520 <br />Day Phone Number 5W680- 6800 51 0_1L807878 FAX <br />SignatureDate 5/23/95 <br />pQ <br />T omas Schoenstei , Projec Architect REV , 4 2 T5- <br />EH 23 008 (Rev 1/7/92) WP <br />3 <br />EPA SiTE #PROJECT <br />CAL 000028349 <br />CONTACT & TELEPHONE # Tom Schoenst�in <br />Tait & Associates 1 <br />F <br />FACILITY NAME ARCO Facility 548 <br />PHONE # 209 478-2723 <br />A <br />C <br />ADDRESS <br />1612 Hammer Lane,�Aton, CA 9-9207 <br />i <br />— <br />L <br />CROSS STREET Brentwood Avenue <br />i <br />T <br />OWNER/OPERATOR <br />PHONE # <br />YI <br />ARCO Products Co. ATTN: Environ. Health & Safety <br />714 670-5300 <br />C <br />CONTRACTOR NAME <br />PHONE # <br />0 <br />N <br />CONTRACTOR ADDRESS <br />CA LiC # <br />CLASS <br />T <br />R <br />HAZARDOUS WASTE CERTIFIED YES NO <br />WORK.COMP.# <br />A <br />C <br />FIRE DISTRICT Stockton F.D. <br />PERMIT # <br />T <br />0 <br />BOARD OF EQUALIZATION # TK LiQ 44-000506 <br />R <br />Illlllilll111111111f1111 <br />TANK ID # TANK SiZE CHEMICALS TO BE STORED PROPOSED INSTALLATION <br />TANK <br />39- DATE <br />T <br />39 <br />gallons <br />ons <br />Oc ane Gaso lne <br />�Ilmmer ' <br />39- <br />— 1i50� <br />al onI s <br />eSzso ne <br />SlammQ S <br />A <br />39- <br />a ons <br />Oc ane as�� n.� <br />.9 m -Y��-- <br />N <br />K <br />39 <br />Cid ons <br />. <br />—81 octQe Gaso <br />Summer <br />39- <br />JjT- <br />51AVAWee <br />39- <br />I <br />P <br />L APPROVED APPROVED WiTH CONDiTiON(S) DISAPPROVED <br />A (SEE ATTACHMENT WITH CONDITIONS) <br />N PLAN REVIEWERS NAME DATE <br />11111111111 i 11111111 �TTiTTTT1fTiTITi-iTT1Ti-iTTTTTTT1TT11T1TTTTITTiT i i l l l 11TTi iTTTiT(TTTTTTTf(TT(T1TTiTT <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WiTH SAN JOAQUiN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN JOAQUiN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "i CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT iS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HiRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br />"I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHiCH THiS PERMIT 1S ISSUED, i SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA." <br />APPLICANT'S SIGNATURE: TiTLE DATE 5/23/95 <br />indicate the responsible party to be billed for additional PHS -EMD staff time expended beyond the 8 hour minimum installation payment. <br />The party must acknowledge this responsibility for the additional billing by signature and date below. <br />Name Tait & Associates <br />Hailing Address 1001 Galaxy Way, Ste. 404 Concord CA 94520 <br />Day Phone Number 5W680- 6800 51 0_1L807878 FAX <br />SignatureDate 5/23/95 <br />pQ <br />T omas Schoenstei , Projec Architect REV , 4 2 T5- <br />EH 23 008 (Rev 1/7/92) WP <br />3 <br />