Laserfiche WebLink
' J O Q I Environmental Health Department <br />.COUNTY <br />APPLICATION FOR UN13ERGR UND STORAGE TANK <br />RETROFIT OR PIPING REPAIR PERMIT <br />THIS PERMIT FYPIRF,13 IM 0AY$ FROM THE APPROVAL MATE. wDICATE RERMI 7 TYPE BELOW <br />[I TANK RETROFIT ❑ PIPING REPAIR; RETROFIT (I UDC REPAIRI RETROFIT ❑ GOLD STARVEVIR UPGRADE <br />F <br />EEA Sile # <br />Project Contaut & Tolephone # Albert Barajas (09) 13-5266 <br />C <br />Facility Name FedEx Ground - Traa <br />Phckne # (888) 972-7581 <br />L <br />Ad�res� 6655 Hoof Way, Tracy, CA 95377 <br />TCross <br />Street <br />Y <br />OwnerlOperator FedEx Freight, Inc. <br />Phone # 901 818-7500 <br />C <br />Contractor Name Jones Covey Group, Inc. <br />Phrme-9 909 972-7581 <br />T <br />onlractor Address B59-5LuGog RariCh Rd, 4VIOO. RmKta Cucamonga, CA 917-0 <br />CA Lie # <br />604431 Glass A,B,Haz,C-14 <br />Insurer Insurance Ccmpany cf the West <br />Work ComP4 WVA506868303 <br />TIDG <br />Technician's Marna <br />Expiratlon Elate <br />IOC Inslallers Name <br />Explradon Date <br />Tank �y tem work area <br />Tank Size <br />Chernicala Stoned CwTentty <br />Date LIST <br />(i,n. 0 PPin9 m^'P. $1 Wk ftwaar, UX I a, Ru.) <br />Installed <br />T <br />Ti - Dlesel STP Sump <br />30,000 <br />A <br />N <br />T2 - Bisset STP Bump <br />30,000 <br />K <br />P <br />❑ Approved pproved with conditions ❑ Disapproved <br />L <br />(F Ai chment With Conditions) <br />A <br />N <br />plan Reviewers � ���� Fh <br />Name ,�� Date ;�— <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE MTH SAN JOACWIN COUNTY 01' 01NANCES. STATE LAWS, AND RULES AND REGULATIONS OF SAH <br />JOAQUIH COUNTY, ENSAR4NMENTAL HEALTH DEPARTMENT. OWNER OR LICENSEE AGENT'S SIGNATURE CERTIFIES THE FOLI,CWNFS; 'j CJQI TIFY THAT IN <br />774E PERFWMAI`iCE OF THE WORK FOR WHICH THIS PERMff IS ISSUED, I SHALL NOT ELWI-GY ANY PERSON IN SUCH A MANNER A$ TO EWE -COME SLIBJECT TO <br />WORKER'S Cpi. KX$AT10N LAWS OF CALIFORNIA,' OON-MACTOR'S RIFRFNG OR SUE.OUNTR&CTING SlGNAT'URE CERTIFIES THE FOLLOVANfir 'I CERTFFY <br />THAT 1N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I$ I$SLIi•0, I SHALL EMPLOY PERSONS 61JEWECT 70 WORKE7T'S COMPENSA-noN LAWS <br />OF CALIFORNIA.' <br />Assistant Envlronmenlal <br />+�q L's 31 exlwn r� -nu Cam liance PM n -m <br />BILLING INFORMATION: <br />Indicate the responsible party w be billed for additional EHO staff time expended beyond permit payment coverage per <br />tank. If the party clesigrlated I*ew Is different than the permit applicant, e.g. property owner, the party must <br />acknowladgu this rsupomlbility for the biiPrig by sIgnalure end date below. <br />Assistant Environmental <br />P!. mLF Albert Bara.aS TnErnrlliar� <br />Coce PM PHONi= IV (909 213-5266 <br />AD3RE $ 9595 Lucas lunch Ind. Rancho Cucamonga, CA 91730 <br />SIGNATURE <br />2 al ti <br />,1 01167# 41041 <br />