Laserfiche WebLink
Z— 7-63; 5:24PM7Secr3ment�a EMC ;0,6 <br /> 92628,6 <br /> SAN 3OAQUTN COUMrY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WFUR AYE,s®FLOOR <br /> STOCK70N,CA 9SLnZ <br /> APPLICATION FOR UNDERGROUND TANK RETROFIT,OR PIPING REPAIR PERMIT <br /> THIS PERMIT ExPIRFS So DAYS FROM THE APPROVAL FATE. DO NOT WRTrE IN ANY SHADED AREAS,INDICATE PERMIT TYPE BELOW_ <br /> TANK RE ROM PIPM;FEPAIR/F2EmoC Tr —UNDER MiPENSER CONfASNMENT REPA111,11RETROFIT <br /> EPA STrE:CAn98I4455792 PROJECT CONTACT&TELEPhONE #916-9z5-2716(Linda Steiger or Lee Reeve®) <br /> C FACCL-rY NAME 7-Lleven#14117 PHONE#2!,191{63-1259 <br /> L ADDRESS 2725 Country Club Lane-Stockton-California-95201 <br /> L <br /> [ <br /> CROSS S,MLE <br /> Y OWNER/OPERATOR 7-Eleven Inc PHONE#209.429-8466 <br /> C Contras nr Name $a4MMetrto Equlpment Maintenance Comparry,Inc. (Wa=111468) Phono;e#916-925-2716 <br /> O <br /> N Contractor Address 2533 Connie 6five-Sacramento,-CA 9581sCA L[G#502377 Cla-,g'A""C61-D41""Ilan" <br /> T <br /> R Insurer State Campensetion 7nssrrancc Fund <br /> A Work[ogrp,0153660"2 <br /> 7 Other Info rmadon <br /> 0 <br /> R Phone*916-434-0710 <br /> (Linda Steiger) <br /> Phune#t <br /> rank Sb# <br /> T 35 Tank sure Chemicals stared currently J Pravlously Date UST InsCalled <br /> A 39- <br /> N 39- <br /> K 39- <br /> 39- <br /> 33- <br /> P Approved Approved with Candiban(s) DL.approved <br /> L <br /> A (See atiachrnentwlth conditions) <br /> N Plan Reviewers Name Date <br /> Applicant must perform all work in accordance with San 3paquin County ordinances,stete laws and rules and"utatlons of San 30aquln County, <br /> Environmental Health bepartrnent. Owner or Iiccnsed agent's signature certifies the following: I corUy that In the performance of the work for which <br /> this permitis Issued. I shall not employ any parson in such a manner as to become subject to Worker's compensatlon laws Of California. Coatracbor's <br /> hiring or subcontracting signature certifies the fatlowing:I cer*that in the performance nF the work for which this permit Is Issued, f shall employ <br /> persons subject to Warkcrs Compensation laws of Cauomla, <br /> Applicants S[gnuturei Title Linda Steiger-President 13 ate <br /> Billing Informatiog: <br /> Indicate the responsible party to be billed For additional EHD staff time expended beyond permit payment coverage per tiank_ If the party designated <br /> bek)w Is different that the permit applicant,e.g,property owner,the party rrtust acknowledge this responsibility for the billing by slgnAire and date <br /> below. <br /> Name: Sacramento Equipment Maintenautce Company,Int <br /> 2533 Connie Drive-Sacramento-CA 95815 916-925-2715 <br /> Signature <br /> Linda Steiger-President <br /> JEH230038 <br /> (revised 1/31/02) <br /> v,.\county 1 san Joaquin k env' formS k permits\repairs2 <br /> 188-d 600/800 d M-.l E9^.9 ZPE ON 9%E8 01 '09109 0I40ed HTA-loom 9V:80 £O-0149d <br />