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Dec 10 14 07:25a Elit Iv Contractors Inc 2094616 42 P.2 <br />_..._. NV1-RONME'N-TA�L..HEALTH. DEPARTII�ENT <br />AWJ- tAQUPN COUNTY <br />_ fi0Q East"Main Street, St idtton, Califoirtia 95202 <br />Telephony; (209) 3420 Fax: (200) 46"433, <br />APPL1CAMON fOR UNDERGROUND STORAGE TANK <br />RETRQFJT`OR'PIPINIG REPAIR•-PERmrT <br />. fleS PERMICewIRES 180 DAYS PROM THE At'tftCv& T)ATG tP>bIG►7 E PERMfT TYPE T3E4QW: <br />[ITANKRMOFrr.`-DP04KGREPAWJRETROFI'r 0 UDC REPAiI RE1ROFrr 0 COLD STAR T"R UPGRADE <br />F EI?A Sita # Plojed.corttact & Tefepltone <br />0 i'aoNiry Name Phone'Al <br />I Address el `C`' <br />L 1' <br />! Cross Sit <br />7 <br />Y OwN"OpoMlor ", r 1 Phone <br />C <br />a CorltrdCiorName ', -' * � •. ; � PtronQ # - �•��� �� w' ; - r J <br />N CnritractorAddreIm <br />T .� , !f - il ! {` �'Lt �1 i CA LJC # t -� C. Class - <br />A Instjror r- <br />`1 > i -'Lyn Work t74tnp # �' 'r <br />T PO ToChrlldw'S Name Expiration Date <br />R ...IGC installer's-Namo.IraUon Data <br />Tank hs. sr ter„ a w`ea C s►x ee l Tank Size Chemo Stared Currently fate UST <br />instaW <br />T <br />A <br />N. <br />k <br />P Approved Approved with Conditions <br />.Dis2ppmved <br />+—•_-- • t With Gond}iionsj n J <br />N Plan Revlowem NameA4 DateM3PL <br />ICANT MUST rJMWORM AM WORK IN ACXXXt pANCL VWM SM JdAQUW COUNTY ORDINAN�;9, STATE u <br />AND <br />JOMWIN.COc NTT. Ew RONMENTAL'•HEAt.TN O~ MENT, OWNER OR LCGNSEA AGENTS SMNATt1RH CE S THE FOtJ.Ow►Np:. M FOAM AND LATKCWTOF SAN <br />rd PERFORMANCC;OF.TH12 WORK FOR WHICH THIS PERMIT 0 ISSUED; i SMU NOT EMPLOY AN !•PERSON lN.SUGt A T3.AS.TD 4i�.'OR� Si/B CT TQ <br />Vv0THAT IN RI( NSN1ApM.-► -1-Mg e`JilIFt7�Fjfr1 ' t:4rtTRJyCTOpi5.NI PIO.OR sU9CONmcli iO 51 1WTI1R£ em-nFIES THE mLommc_ 9 CERwy <br />F'CACIFORNI WQRNANCG 9 HE WC�R1C FOR WFIIpH fH15 ?E7ev11T IS, ismak I SHALI.' EMPI:[IY PIM. SONSS SU8JF" TO WORWR'S O MPENSATION tAWS <br />rirs sipnalu�e��� f!'A � 4'•Jti i �� r - ,••�.� �' � rt .a ,; ;n � . d." •; .. l _ l � • ') � r � _ <br />ma <br />........------.._.._ ..... ............ .. , .•.:..._.•DILitIQG'INFORMfi710N:. <br />_.JI►dicsyte fho rr�spculsibie_p°dY irk 6 billed fob-addrtior+af-lrt4i�stafl-Utneexpended,b.9Ygnd: permit payment wvwerap e.m tanlc:..It . . <br />q+�dQslgi7stecl.:Holow_is�ittfY�ri4 iti til; permit <br />I>e3ponsibilit r�forttle bdiin &9 property amor,-• the• -party must ecltrraw�dge. this <br />.9hlt.s!9 i date,bolo�w.-• <br />AMIiES$t DC b <br />S NATUR r " + ti:t`r_ t OATP,. <br />. E?{�0038 (r+aviaotl•r)B17111) • • <br />