Laserfiche WebLink
c <br />4WIRICNMENTAL HE41 01 ISICN <br />APPLICATION FCR UNDERGRCL 0 T C SURE ?£ZVIT <br />APPLICATtCN FCR PEt%.tNENT/TE4PCRARY CLOSURE CR ABANCCNMENT IN PLACE OF UNOERGACUNO HALARCCUS SUBSTANCE ST GE F ILITY <br />THIS PERMIT E:(PIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT A,RITE IN ANY SHADED AREAS. INDICATE PERMIT TTA: 3 cw. <br />REMOVAL TE.4PCRARY CLCSURE CLCSURE IN PLACE <br />'EPA SITE / � bb320Z6 PRC -ECT CCNTACT 3 TEL=PHCNE Z0,?) e14,S_21go %d-oe Kecar7'e,Q. <br />F FACILITY NAMECly/y��L PHCNE �0% y6B—bc�12- <br />A W, wL.C. <br />C ADDRESS /SO /Jav/ %/9 <br />L CRCSS STREET �Josf,:Zwe_ <br />I <br />T CWNE2/CPERATCR,may �^ L E ZO 9 (7/4. 8 <br />Y C. -O G�.�-t / y 7 <br />C CCNTRACTCR NAMEIjC,QIU/c/t�rL �IJ� M�rr�zt�i�-� SG�YLU�c.E�, PHCNE at �9 935 <br />0 <br />N CCNT2AC:CR ADOR£S52s,-6 � �-� CA LIC 9 S%�SS3 CLASS <br />T oc,�sTazl �o�/ , <br />2 INSI:RE2 z tK Ll - Rus RI L �MQ Iv�Mi? '•CRX.CrMP._l C <br />A <br />C FIRE DISTRICT IPE14IT 9 <br />T <br />0 LA3CRATCRY MME,4 j,�t y- Pl,Ioi2►T �Ol�w-7/va+Ts (.p�►oue�?vz, ?NONE x zvq 27 zi7 S-- <br />SA."PL:NG F11.4 PHCHE x <br />111 ll ll! ll 111 ll 11 111 ll 111 ll 111 <br />T IK IO S TANK SIZE CHEMICALS STCRED C RRENTLY/PREVIOUSLY DATE UST INSTALLED <br />T 39- .0,2r-Y3V-7 -2 YS- coo i li,{aCLrWDL�n S L� Ju-�K o lg U <br />A 39- <br />Y 39- <br />4 39- <br />39- <br />39- <br />P 1llllllllllllllllllllll1111111111111]llllillllllll1111111111Hill 11111111111111111111111111111111111111111111111111111111111 <br />L APPROVED APPROVED WITH CCNOITICN(S) DISAPPRCVED <br />A (SEE ATTACHMENT ITH CCNOITICN ) <br />N PLAN REVIEWERS NAME DATE <br />111111111111111111111111111 of111111111i11111111111111111111111111111111111111111]]1111111111 In <br />APPLICANT MUST PERFCRM ALL WCRK IN ACCCROANC: WITH SAN JCACUIH COUNTY ORDINANCES, STATE LAWS, AND RULES AND RECULATICNS OF <br />SAN JCACUIN CCLWTY PUBLIC HEALTH SERVICES. CW'NER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FCLLCWING: "I CERTIFY THAT IN <br />THE PEQFCRMAHCE OF THE WCRK FCR WHICH THIS PERMIT IS ISSLID, I SHALL NOT EMPLOY ANY P£RSCH IN SUCH A MANNER AS TO 9ECCIE <br />SUBJECT TO WCRKERIS CC.4PENSATICN LAWS OF CALIFCRNIA." CCNTRACTCR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br />"I CERTIFY THAT IN THE PERFCR.MAHCE OF THE WCRX FCR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSCNS SLHJECT TO WORKER'S <br />CCMPENSATICN LAWS OF CALIFCRNIA." <br />APPLICANT'S SIGNATURE: //�y� TITLE L637lh7A�ll2. DATE 31,1;)Y2- <br />EH <br />1i)YZ <br />EH 23 046 (Rev 2/8/91) ft Page 3 <br />