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06-29-1999 08:13AM FROM TO 9435059 P.03 <br /> APPLICATION FOR UNDERLlt01 ANY U=OFTT, OP. PIPING REPAIR PERMIT <br /> THiS 2ERMIT EXPIRES 90 DAYS FROM T-tM APP2OVAL DATE- 00 NOT WRITS IN ANY 5-- DED �E�• S.vDICT:3 PERMIT '!AP3 BELOW: <br /> 1NK RMOPIT _ PIP= REPAIR <br /> I E2A sl= A N/A I PROJECT CONTACT = TSLEPBONE s Bill Merchant (Arco) (916) 684-61 5 <br /> F• FACILITY N,ME Arco # 6080 _ PRO=* (Mg) 993-9140 <br /> T {- <br /> C I ADDRESS <br /> I 1 <br /> L I'cROss STnzT Harlan Ave. <br /> I <br /> T I OWNER/OPERATOR I PPANE k. I . <br /> YI Areo '/ John Serpa I (209) 983-9140 1 <br /> c 1 CONTRACTOR NAME Henderson Construction I "0' x (209) 943-5058 � <br /> 0 <br /> N I coNTRAc.oR ADGREss 2080 E. Fremont St. 1 ""c 3721876 1 C'�A B Haz Mat 1 <br /> T <br /> R 1 Fremont Compensation I .cone.A81101501 <br /> 1 <br /> A <br /> C I OT= INFORMATION I I <br /> T . <br /> o I I Psoxe.r I <br /> R <br /> I' 2_gcbm 3' 1 <br /> lllulullJT�ANK IDl*illnuiirl� <br /> TAN[ SIZE I Cz212C:AL3 STORED CUR3tEN'.S.Y/P3tEVIOUSL7 I DAPS,'USS �LSTALi.�'D I <br /> 12,000 al. 1 REG un nown 1 <br /> T1 39- ga . 1 I unknown <br /> A l ;9. 1 12 000 gal. ISU unknown <br /> 'R..1 39- I I I <br /> 1'19- 1 1 l 1 <br /> �11lJll.lillll11111:Mil.lllllllllllllllllflilflllillilllii111J111111111111111111.111111111111if111JJlJIIJlilllllfltifllllllllllfl <br /> L 1 _ APPROVED AQPROVED 41'Q COKDI:ZON(S) DISAPPROVED 1 <br /> A 1 (ses ATTACacMrr A&.s CONDrr_CNS) i <br /> Y 1 ?LAN REVIEWERS NAME TATS 1 <br /> -FT11111l1:11l111111lf1.11:11111111Tllllll1J,1111111111i.1111111i11111111111l1111111111111111111111l1111111111.11111111111111J1i111!!11 <br /> APPLICAW MUST PSRFORM AL:. NORX 1N. ACC'DRDANC3 N173 STN .'OAgV_-'`i COUNTY ORDr-VQF .- STATE i.xwS. AND RVLZS Aero-==TIONS OF <br /> SAM JOAQVTN COUNTY PURL=C KFALT:t SR_QVICES. OWNER OR ucMISED A6Zan,s C2ATI?23S TM 20UOWM: •I am=ry -..-,AT ni <br /> VM ?ERFORkV= 08 TIM.-WORN ?OR MUCY '—S MNI': *S ISSUED, _ MUT 1. NOT M_LOY ANY -PERSON T_Y SUCE.A HANKER AS :0 3Lrc= <br /> 5uw2c- TO WORKER'S.COMPENSATION-LABS OF cXZ_'ORNTA..' CCNTRAC.'9RI S 3-_ r:IC .`R SOSCONTRACI':NG SIG'7ATURE =TIeTES THE FOLLOWING;I <br /> •'I CERTIFY TXAT IN THE. 2's?SOR(4n2 OE T-- FOR MICH ?KIS PMUgIT :S ZSSUnD. I SHALL LMPLOY P= ONS SDBJECT 0 'AOPJCR'S I <br /> CON-PR SATION LAWS Of CALI'70RNIA.•' <br /> _ I <br /> I <br /> APBLZCA.`1T�5 sIG.vATUR&: < l -_.LE Off;c.Mapo*g.;r nA= .6-28-QQ <br /> ILLING INFORMATION <br /> .ndic* ate' the responsible party ' to be. billed for additional pHsEHD -staff time <br /> xperided ''beyond ' permi�.'payment ..coverage per tank. If. the . party designated <br /> elow .is different.: .than the permit applicant; e .g,' ..probert'y. owner, the party .. <br /> last ack zowl.edge this responsibility for the:' billing by : signatiure and date <br /> elow. <br /> ameH.nd•er5.op Cotrstructio Y SS. 2080 E. Fremont St. phone number(209) 943-5058 . <br /> ignature -i <br /> H 23-003.8 <br /> . 1 . <br />