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v <br /> Hazardous Materialq San Jose Fire Department <br /> (���� Bureau of Fre Prevention <br /> JC1LV J05 Storage System Per. Four N.Second SL,Ste.1100 <br /> GrTIAL or srnms vAUEY San Jose,CA 951111305 <br /> / <br /> `� Phare::(40/8),2774659 <br /> Associated Building Folder(Permit it). Folder/PenniW. -2-0 0(0 V —T (e-HZ <br /> r PROJECT/FACILl3'Y LOCATION <br /> 4 <br /> Business Name: OPGC,p 6011 Date: It_/ Zq / 07_ <br /> Address: 5285 1r_QdPO San Jose,CA,Zip: gf)z9 <br /> Nearest Cross Street Contact Personmfle: A no!�Tp, lj n Ph:(4250 A23 -5566 <br /> AP?,. :' oRMA N ---M A,,_ ...` `n z,. nom::: ' <br /> Business Name: Ppc yaLk1L <br /> Mailing Address: Vo 8"5U45: gm 9EO(nb city. SAd ao.�n State:CA Zip: qg5j n <br /> Contact Person: pwrc,) r vlon- Tide: rn[ rL( /Il ear/ <br /> Phone:Lg25'j 823 - 8&bG or 2S �_- ?qoj e-mall address: <br /> Business Name <br /> Mailing Address: 329 Pat1e Pte. San-d0Se1G4r&pe &dv a CA 94512) <br /> Contact Person: (110.11-)C Nloprurn Title: 5ajf Q <br /> Phone:000i 4(n J or (_) -_ e-mail address: <br /> 'San Jose City Business License Number. lkdDrA76 Expiration Date: / / 8 L-4f I <br /> 'Worker's Compensation Number. SP�A14003ZOZ Expiration Date:L/31 /03 <br /> 'State Contractors Dcense Number and Type: af31{OO2 Expiration Date: 0? / 1%_/�r� <br /> 9f totem ten contractors information sheet most be submitted with a [cation. <br /> WORK PROPOSED (Select One) TYPE OF PROJECT/SYSTEM:(Select One) <br /> N closure ❑Facility Partial Closure ❑Hazard Compressed Gas/Cryogenic System ❑Variance <br /> ❑Repair ❑Facility Full Closure ❑Inert Compressed Gas System ❑Battery System <br /> ❑New Installation ❑Alteration ❑Other Hazardous Material System(NOS) ❑Metal Finishing(Rating Line <br /> ❑Removal WTemporary 1J5TGOSv"_ ❑Aboveground Tank/Piping System(liquid) [IFacility Closure <br /> Noe: ldnrierymurd Tanq iplg System or varance,must Wriderground Tank/Piping System(liquid) ❑LPO.Tank Piping System <br /> nave eaeitional applications anacned to Nis fon. <br /> .*4ys;SEM COMPONENTS IsRIMARY CGNTAMER' `,-"lr2AECDNDARY-CONTAIMMENL: <br /> .'.tiazatdas Ma"is Stored � Construction Material `S¢c(Volune Edtsstiuition Saa(Vak ;- <br /> Pi Deno etc. ..lG�be"dot 't*am•,y' <br /> 1 0.200 <br /> 2 <br /> 3 <br /> d <br /> r 5 <br /> Attention Contractor. <br /> This permit is being issued pursuant to the requirements specified on the attached San Jose Fire Department Plan Check It is your <br /> responsibility to post this document conspicuously at the job site prior to commencing work. You are to have an approved set of plans and <br /> San Jose Fire Department Plan Check available at the job site. You must contact our office to schedule all required inspections at least <br /> 48 hours in advance. This permit is valid for 180 days from date issued. The project must be completed by this date,unless prior written <br /> approval for e)dension is given by the San Jose Fire Department. <br /> APPDCANra NAME Fleaaa Pdnq lrr E(Pfaase Print) AP CANPS a1DNATURE DATE <br /> FIRE DEPARTMENT USE: <br /> Date a B r Inspectors Comments <br /> Plans Reviewed 11 / I) / OZ <br /> Primary Containment /_/_ OF <br /> Secondary Containment /_/ <br /> Monitoring System <br /> Other. <br /> Final Inspection l JZ/-677--- <br /> W <br /> Z r V9 / /✓ f� 03 <br /> r� Fmm No.N0.1a3(mer.fq]) ComSWHITEPennit Fila PINK-Applicant H Copy-J Sge <br />