Laserfiche WebLink
t-tvRIR,tr n:tt-ff.til-tetr.tt.tvti,ti:tt-tt-tt.ty-tl-t3-tt-ti:ti:tx'l y`t-tvtt-tt. <br /> APPLIC 'Y FOR PERMIT , SAN JOIGUIN LOC1L',BELLIb�flICT <br /> f t: UYDIRCROUIID TANK t: 1601 E HAIELTON LYE., STOCKTO1 <br /> t. CLOSURE OR 111EDOUXEIT t. Telephone (2091 168=3120 t: <br /> t-tt-tt-t�ti:tt-tt ti:txtt-ttt-t111:Ir-R,tt-tt-tt-tZ-r;-tx-ff.ti:tt-t-tt:tt-t;-ty-tt-tx-tr-tt'. <br /> APPLICATION FOR PERKINEKT/TEMPORIRY CLOSURE OR 18IIDO8MFNT IN PLACE OF UHDERCROUMD HAZARDOUS SUBSTIWCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 10 DAIS PROM THE APPROVAL DATE. DO NOT 11178 !Y 111 S1610 AREAS. INDICATE PERMIT TYPE 1ILOY: <br /> 26EdOVIL TEMPORARY CLOSURE ABIVDONMENT IN PLICE <br /> EPA SITE I O 3 PROJECT CONTACT i TELEPHONE I G Ril/•�� <br /> F FACILITY 1111 // PHONE!if <br /> A ti .�E� wio <br /> C ADDRESS <br /> I U /� / ✓ <br /> L CROSS STRAIT <br /> T OWNER/OPERATOR "��5 �,�: p � PHOWE ) E <br /> C CONTRACTOR YAK$ 7 PROBE ! v7 0 't/ s 3`/ Lc <br /> I{ J <br /> 0 6 <br /> I CONTRACTOR ADDRESS _ C1 LIC;! SS CLISS <br /> 3 <br /> T <br /> R INSURER ti YORC.COKP.! U �� <br /> A <br /> C FIRS DISTRICT ' PERMIT 11I1SPTRr 77 <br /> V,4T <br /> 0 LABORATORY NINE 0yx PHONEAD <br /> I <br /> k SIMPLIYG FIRMA SAMPLIXG Hill0 <br /> w a_ ac <br /> TAH! ID I TAW[ SIZE CBEXICILS STORED CURRtlTL'1 CHEMICILS STORED PREVIOUSL <br /> T 1� ��/�e✓c�0 7 he <br /> A 39- a y 3 -o y O o, .�! � �r •.,rte <br /> r 39- <br /> 1 39- <br /> 39- �{ <br /> LIST 100ITIONIL TANK IHFORHATIOI IS NEEDED 01 SEPIRIIE FORK <br /> PAPPROVED _APPROVED VITH COSDITIOtlS I� DISAPPROVED <br /> L (SEE 1TTACUMENT VITR CONDITIDIS) <br /> 1 PLAN RBVIEVERS WE �L�6,2t� �� �' DATE <br /> N 11 <br /> APPLICANT MUST PERFORM ALL YORK 11 ACCORDANCE WITH SAN JOININ CDUKTY ORDINANCES, STATE LAYS, 110 RULES AND REGUL0 1ONS <br /> OF THE SII JOAOUIK LOCAL HEALTH DISTRICT. OYHER 01 LICEWSED AGENT'S SICKITURB CERTIFIES THE FOLLOYINC: 'I CERTIFY THAT <br /> II THE PERFORMANCB OF THE WORK FOR YBICH THIS PERMIT IS ISSUED, I SMALL 101 EMPLOY ANY PERSOW IN SOCK KIYNER 15 TO BECON <br /> SUBJECT TO YORIEt'S COMPENSATION LAYS OF CALIFORNIA.' CONTRICTOI'S HIRING O2,1,SUECOYTRACTI9C SICNITURB CERTIFIES THE <br /> FOLLOWING: 'I CERTIFY THAT 11 THE PERFORKINCE OF THE WOR( FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOT PERSONS SUBJEC <br /> TO WORKER'S COMPEISITION LITS OF CALIFORNIA. i <br /> CELL FOR INSPECTIONS AT LEAST 40 1-IOUR'S IN ADVANCE <br /> SIGNED } !�-- DATE. <br /> OFFICE USB ONLY-4V 11 016 12/11 j} <br /> SiSSSiSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS4SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS;SSSSSSSSSSSSSS;SSS;;S�SSSSSSSSSSSSSSi3S5SS <br /> STEEPS I COMP I I LOC CODE I DIST COD AMOUNT DUE AMOUIT RCVD I CLIICISB ' I RCYD BY 1 DITI RCYD PERMIT I <br />