Laserfiche WebLink
APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN :OACUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "1 CERTIFY THAT :N <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 IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA." <br />i <br />APPLICANT'S SIGNATURE: -T, TITLE DATE <br />EH 23 046 (Rev 2/8/91) ft <br />(Rev 4/8/91) <br />Page 3 <br />ENVIRONMENTAL HEALTH DIVISION <br />g;&gjyq <br />APPLICATION FOR UNDERGROUND TANK CLOSURE <br />PERMIT JUL 0 <br />7 1992 <br />APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDI E+M1"IjEjTPF. 9 LOW: <br />X REMOVAL _ TEMPORARY CLOSURE <br />CLOSURE IN PLACE PEWIT/� <br />EPA"" B 5 Q Ts <br />PROJECT CONTACT & TELEPHONE S <br />Marshall Cloud (209) 832,-�9c9J08 <br />F <br />A <br />FACILITY UMDDRW-Tracy <br />PHONE @ (209) 832-9908 <br />C <br />ADDRESS 25600 Chrisman Road, Tracy, California 95376 <br />L <br />1 <br />CROSS STREET Schulte Road <br />T <br />OWER/OPERATOR <br />PHONE Y <br />Y <br />DDRW-Tracy <br />(209) 832-9908 <br />C <br />CONTRACTOR NAME IT Corporation <br />PHONE 9 (510) 372-9100 <br />0 <br />N <br />he g B?Ornia 5 Paco 4Qulevar 94553 <br />CONTRACTOR ADDRESS Mart5 inez <br />CA LIC # 137422 <br />CLASS ASB,B,C57 <br />T <br />R <br />INSURER Crawford and Company (415) 342-6470 <br />WORK.COMP.S WC1122514 <br />A <br />C <br />FIRE DISTRICT <br />PERMIT 0 <br />T <br />0 <br />LABORATORY NAME IT Cerritos Laboratory <br />PHONE 0 (714) 523-9200 <br />R <br />SAMPLING FIRM IT Corporation, <br />Martinez, California <br />PHONE 0 372-9100 <br />(510) <br />TANK ID <br />TANK SIZE CHEMICALS STORED CURRENTLY/PREVIOUSLY <br />DATE UST INSTALLED <br />39--r� — <br />250 gallon regular <br />gasoline <br />unknown <br />T <br />39- <br />A <br />39- <br />N <br />39- <br />K <br />39- <br />39- <br />39 <br />Jill 11111111111111 Jill 111111 Jill <br />In 1111111 <br />P <br />L <br />APPROVED APPROVED WITH COOITIOI(S) <br />DISAPPROVED <br />A <br />TACHMENT <br />(SEE COOONS <br />ITI) <br />N <br />PLAN REVIEWERS NAME <br />DATE' <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAN :OACUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "1 CERTIFY THAT :N <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 IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA." <br />i <br />APPLICANT'S SIGNATURE: -T, TITLE DATE <br />EH 23 046 (Rev 2/8/91) ft <br />(Rev 4/8/91) <br />Page 3 <br />