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c <br />0 <br />N <br />T <br />R <br />A <br />G <br />T <br />0 <br />R <br />T <br />A <br />N <br />K <br />A <br />L <br />A <br />MtAY-26-1994 16: 0 (' FROM TO P.04 <br />EWR®NMENTAL HEALTH DIVISION <br />APPLICATION FOR 19STALLATION OF LDMERGRMM TANKS ARE ONLY VALID FOR THE CALENDAR YEAR IN WHICH IT AAS BEEN ISSUED. <br />A PERMIT MAY BE EXTENDED INTO THE SEXT CALENDAR YEAR IF A LETTER IS SENT TO PNS -£Ala REQUEWING THIS tXTENS;ON THIRTY DAYS <br />PRIOR TO THE END OF THE C&LElDAR YEAR. A ONE YEAR -- ONE TIME EXTENSION MAY BE GRANTED BY PMS -Fila UPON RECEIPT OF THIS LETTER. <br />DO NOT WRITE IN ANY SHADED AREAS. <br />EPA SITE 25-8317S34P3-1747 M!cr <br />FACILITY NAME <br />ADDRESS 1. <br />FIRE DISTRICT i# * i:::� 17—,7 alp Fes+ { ecopp••t <br />BOARD OF EMIALIZATION 0 <br />pHM # j,CO _ s A -r - <br />PHONE # <br />15bt, 64 c�G7 <br />PHONE It 91too— 311L -1$!o0 <br />CA LIC it 2.38112 lxASSN cel C36 c.. U -N NN't.- <br />um- amp -.4 W CG► 8 ®5'i 'j4ttq <br />PERMIT iN <br />!1!!illiitlii!ltiitttltilltlit <br />TANK ID 0— TANK SIZE CRE41CALS TO BE STORED PROPOSED INST <br />39- A7 c%�, z QO G.�i..L l alert, - ATE <br />39- 3 7 QkL <br />t�A>'c-ifi�w.lrAxa T -E �',Z <br />3 SQ _rte axaxg3 <br />39- r- s.c �® <br />39-.� 11 <br />111111111221111 <br />® APARDVED /APPROVED VITH C310tTION(S) DISAPPROVED <br />CSi:E ATFAr"wC 1T "ITN 0-nimlTIfki52- <br />N PLAN REVIEWERS NAME � f DATE <br />iIIlIIItlltt!!l1tII!HH111111 III Illulvillull III I 1111111111111111111111111111111 Ilttl III III <br />APPLICANT MUST PERFORM ALL W= IN ACCORDANCE WITH SAN JOACUIN COUNTY ORDINANCES, STATE LAYS, AND RULES AND REGULATIONS OF <br />SAN .IOAQUIN COUNTY PUBLIC HEALTH SMMCES. MM OR LICENSED AGENTTS SIGNATU M CERTIFIES THE FOLLWIXG: "I CERTIFY THAT IN <br />TNI: PERFORMANCE OF THE W= FOR WHICH THIS PERMIT IS I . I SMALL Wr EMPLOY ANY P0tSGN IN SUCH A 1W1NER AS TO BEM14E <br />SUBJECT TO WORKERIS COMPENSATION LABS OF CALIFORNIA.* CDN °S MIRING OR SUHCxlNTRACTrNG SIGNATURE CERTIFIES THE FOLLOWING: <br />at CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL. EMPLOY PERSONS SUBJECT TO 'S <br />CMPEM!SATlOX LAWS OF CSILIFORNIA . �O <br />APPLICANTS <br />Indicate the responsibte party to be bitted for additioal PRS -EBD staff time eipended bayawd the 3 hour ainimsn installation paymant. <br />The party must acknewiedge this responsibility for the additional billing by signature and date below. <br />Mailing Addrass <br />Day Phone Nuwber <br />S <br />Date <br />Ev 23 am caev 1/71W) WP / <br />rya <br />/-1-d�Ld ...'�-fir G�,><�Fx�irV' � ��u ?/�'�r•�-�� �',c:..�.}f'�(.Zk..� �.t�„ 1� •.,./- L""Z%�`� <br />Y <br />CAC- e <br /><' S)o--i C j �+�,c..< i` c.t-� G�21 L" ' tiJ % ` `` ` Sze C`f G'b , <br />