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✓JO—G7—1777 YUCI. I DHI'I r-MU111 I U <br /> APPLICATION FOR UNDERGROUI. ANY 9ATIOPIT, OR PIPING REPAIR PERMIT <br /> TUMS PERMST EXPIRES 90 DAYS FROM TIM AP?ROVAL DAT$. 50 NOT NRS^.'"' IN LNY 31,== AREAS, INDICA I PERMIT !VPS $$LOW: <br /> �TANK RETROFIT ?ID2:7G REPAIR <br /> E?A SITE 0 CAL000028355 I PROJECT CONTACT TSLEPWONE ' Bill Merchant (916) 684-6125 (Arco)I <br /> FACILxT": 'E Arco JL 95 O"S (209) 931-5976 I <br /> ADDRESS A i nn N_H5 ghwav 99, StocktonI <br /> CROSS STR.EST Hammer Lane <br /> 1 oaT� I PI'ANE x 1 <br /> Merce'des.L. Acosta 1 (209) 931-5976 <br /> C0NTL`CTOR NAME -Henderson Construction i ?YON` x (209) 943-5058 <br /> I CONTRACTOR ADDRESS 2080 L-C 3 <br /> I C <br /> 2080 E. Fremont Street 7218.76 A B Haz Mat I <br /> " Fremont Compensatio __ � ' 811 3501 <br /> Or= INFORMATION <br /> I I. PRONE.k 1 <br /> 1 ?_SON. <br /> Hill 1111 <br /> i TAMC ID S 1 TAN[ SIZE 1 CZEMICALS STORED CVRREN7,LY/FREVIOUSLY 1 DATE'QST ZNSTAVL--D <br /> 1,]9- : I 1 <br /> i s9- t a I 1. n cnown 1 <br /> 1: =9- 3 t Z2, ! �� I H }F�e4a�- 1 <br /> I I I <br /> l D9- J I f I <br /> 1' <br /> 39- t I ( I <br /> H 111111.1111111111111111.111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111III I' <br /> 1 AP°4oVED APPROV® NI_P CONDITIONS) DISAPPROVED 1 <br /> 1 (szA ATrAc ma= x,.z cOmIT:=5) <br /> 1 ?L 1N REVIEWERS•NAME ' SATS t <br /> HILI11I1:1uil1111111.111111lN1111111.i1111111111111.I111i1111l1111111llilllllllllu11i1111111uN11ifUilaill'i111111111111t111u i <br /> APPLICANTMOST ?ERFORM ALL WORK /N. ACC'DRDMCE ifIT3 SAN =AOOI4 COUNTY ORDr.X_' `Cr'S. STATE LAWS, AND R== AND•RELATIONS OF <br /> $AN JOAQUIN COUNTY PURL-C KEALTIC SiRVZCS'S. OWNER OR -LICESSED AG' er'S SZGVA^'92 C°�TIFI9S jai 20"OWI*1C. "I C R-.%F': INAT IN <br /> TEE ?ERFORM?NCZ 05 T=. WORX ?OR Va= TUS PV-WI'T *_S ES=, _ SHALL NOT 14?LJY ANY 4ERSCN IN SQCE.A MAN27F3 AS TO 2ECCXr6 I <br /> 5GSv-ECT TO AORIO:RIS.COMPENSATION LAWS OF CAL:FORNTA." CQNTFAC:7R'S SIRING OR SM1CONTR =1-'aG SIGNATURE ORTIFISS 1"NE FOLLOWING:I <br /> "Z CSRT.1YY THAT IN THE. PI FOAMANC2 OF :ti = <br /> WOA,R FOR WHICH T=5 ? MIT ZS 1557-1, I SH-ALT PLOY PSRSONS 5.a.."ECT O 40R7GR'S 1 <br /> COMPENSATION LAWS OF C.ILIFORNIA.• I <br /> APPLI'CANT'S SIG.VATt7 ; 'Z ��/� 7:TLE nffi(-a mnnagor DAM 619R/9__ <br /> LLING INFORMATION: <br /> ,di C' ate the responsible' party to be. billed for additional P?IS-EHD staff time - <br /> :perided beyond permit. payment .. coverage per tank. If' the . party designated <br /> !low .is differ ent.: .than the permit applicant,' e .g.' ..property, owner, the party <br /> :st acknowledge this, -respgnsibility for the billing by : signature and date <br /> low'. • <br /> ;hie '`Hendet-son ConstrNa t $dz'eS. 2 0 E. Fremont St, phone number C209) 943-5058 <br /> gnat.ure ,2_ • ; ' <br /> 23-003.8 <br />