REMOVAL_2000 - Laserfiche WebLink

Home Browse Search

SAN .I"4QUIN COUNTY PUBLIC HEALTI 'ERVICES `►ENVIRONMENTAL HEALTH DIVIS 10N APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT THIS PERMIT FOR PERMANENTIT'EMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE TANK(S) EXPIRES So DAYS FROM THE APPROVAL DATE, DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE; E7 REMOVAL ❑ TEMPORARY CLOSURE 0 CLOSURE IN PLACE APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS, FEDERAL LAWS. AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: •I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SWILL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- APPLICANT'SSIGNATURE TSE Admin. Assistant DATE 4/13/00 ❑ APPROVED X�kPPROVED WITH CONDITION(S) ❑ DISAPPROVED (SEE CONDITIONS BELOW ANIUOR ON ATTACHMENT) PLAN REVIEWER'S NAME DATE -5L$ ANY DEVIATIONS FROM T IS APPLJCATION MUST 81 SUISMITTED TO ENID FOR APPROVAL PRIOR TO COMMENCING WORK CONDITIONS: Toc�--r,-7 Y— . .. -_12-. -/ o - ,_a — ._,./7. 41A FACILITY INFORMATION TANK INFORMATION EPASITE#CAL000152548 PROJECTCONTACT Architect Gary Cathcart PHONE# 209-464-4033 FACILITY NAME San Joaquin Mosquito & Vector Control District I PHONE# 800-300-4675 ADDRESS 7759 South Airport Way, Stockton, CA 95206 INSURER Legion CROSS STREET Stimpson Street WORKER COMP# WC 311897 9 2 OWNEROPERATOR John Stroh 39- PHONE# 209-982-4675 APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS, FEDERAL LAWS. AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: •I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SWILL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- APPLICANT'SSIGNATURE TSE Admin. Assistant DATE 4/13/00 ❑ APPROVED X�kPPROVED WITH CONDITION(S) ❑ DISAPPROVED (SEE CONDITIONS BELOW ANIUOR ON ATTACHMENT) PLAN REVIEWER'S NAME DATE -5L$ ANY DEVIATIONS FROM T IS APPLJCATION MUST 81 SUISMITTED TO ENID FOR APPROVAL PRIOR TO COMMENCING WORK CONDITIONS: Toc�--r,-7 Y— . .. -_12-. -/ o - ,_a — ._,./7. 41A CONTRACTOR INFORMATION TANK INFORMATION CONTRACTORNAME Ramcon Engineering & Env. Contractin , Inc. PHONE* 916-372-7535 CONTRACTORADDRESS3751 Commerce Dr, W.Sacramento, CA I CA LIC# 510034 CLASS A-Haz INSURER Legion Insurance Company WORKER COMP# WC 311897 9 2 FIRE DISTRICT 39- PERMIT # LABORATORY NAME Kiff Analytical COUNTY yol PHONE# 530-297-4800 SAMPLING FIRM Kiff Analytical PHONE # 530-297-4800 APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS, FEDERAL LAWS. AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: •I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SWILL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- APPLICANT'SSIGNATURE TSE Admin. Assistant DATE 4/13/00 ❑ APPROVED X�kPPROVED WITH CONDITION(S) ❑ DISAPPROVED (SEE CONDITIONS BELOW ANIUOR ON ATTACHMENT) PLAN REVIEWER'S NAME DATE -5L$ ANY DEVIATIONS FROM T IS APPLJCATION MUST 81 SUISMITTED TO ENID FOR APPROVAL PRIOR TO COMMENCING WORK CONDITIONS: Toc�--r,-7 Y— . .. -_12-. -/ o - ,_a — ._,./7. 41A TANK INFORMATION TANK ID # TANK SIZE TANK CONTENTS (PRESENT & PAS DATE INSTALLED 39- % 7 e - 0 716000 Gallon Gasoline Unknnwn 39- c - - a 9' 000 Gallon Oil for Mosquito Abatement Unknown 39- 39- 39- 39 - APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS, FEDERAL LAWS. AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: •I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SWILL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.- APPLICANT'SSIGNATURE TSE Admin. Assistant DATE 4/13/00 ❑ APPROVED X�kPPROVED WITH CONDITION(S) ❑ DISAPPROVED (SEE CONDITIONS BELOW ANIUOR ON ATTACHMENT) PLAN REVIEWER'S NAME DATE -5L$ ANY DEVIATIONS FROM T IS APPLJCATION MUST 81 SUISMITTED TO ENID FOR APPROVAL PRIOR TO COMMENCING WORK CONDITIONS: Toc�--r,-7 Y— . .. -_12-. -/ o - ,_a — ._,./7. 41A