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Environmental Health - Public
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2900 - Site Mitigation Program
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PR0508043
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
5/24/2021 7:04:54 PM
Creation date
5/24/2021 11:28:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0508043
PE
2960
FACILITY_ID
FA0007905
FACILITY_NAME
CHEVRON PIPELINES
STREET_NUMBER
35500
STREET_NAME
WELTY
STREET_TYPE
RD
City
VERNALIS
Zip
95385
APN
25526003
CURRENT_STATUS
01
SITE_LOCATION
35500 WELTY RD
P_LOCATION
99
QC Status
Approved
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EHD - Public
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APPLICATION FOR YVFLLIPUDIP PERMIT EC ' } �Jy� <br /> SAN J ENVIRONMENTAL HEALTH 0 VSIERYICES <br /> ON �� JAhI 1 P )gra <br /> P 0 BOIL 380,446 N,SAN JOAQUIN ST,STOEXTON.CA 96201.389 <br /> {2091 468-3420 <br /> NOR-REFLROATELE PERMIT EXPIRE!1 YFAA FROM DM ISSlM <br /> IC..p6l&if Trlplkslsl <br /> APPLICATION IS HERE BY MADE TO ME SAN JOAGUN COLLM TY FDR A PERMIT TO,CONSTRUCT ARBOR PHI TALL TIIE-ORK DEMCAIREO.TH1B APPIJCATIOH IM MADE IH COMMIAME WTII SAH <br /> �ADUIH COUNTY DEVELOPMENT TRlF.CHAPTER 9-11115.3 AND THE STANDARO6 OF SAN JOAOV hI COUNTY PUBLIC HEALTH SEAY,CES,EN ARDNMEMAL HEALTH gySgN. <br /> Joel AIDM%"Fk AM[ CI <br /> TY�' rAncEi 3IxFJArNr4 <br /> OWNEM.M NAME P,ao��r,- R o��FGYS _ADDAESS O �G.V�' 1`� rte'' �-i.O—LST—d 3 <br /> R <br /> coNrAACTOR / c>LAry ��yA ezlrt `.1wJF T ADVA(SIL 21601 RSV--g CZ � E �n1aHEF 4-53$ln�F�4 <br /> SVe CONTRACTOR E-TJ �FL.��! ryy Ti Er�`�- —AOD11ESf -iqoj vw 7.i.m Ca Iyd PRONE, <br /> TY"OF Wn11FUMP: ❑NEW wFIL 0 REF4ACFMFMT WELL ❑TAOKTONNo WELL f Q OTHER 5767- <br /> ❑INSTALLSTTOH ❑WELL$YST EM RLPAIR Q CROSSCONNEC T EEPADI ❑VAPOR ESTRAC 161E P.RLL F J <br /> F AVMy <br /> R-,'f� <br /> E]H—Q A-.k H.P. OCPTH PL-P JET FT. FPMT MIA TER LEVEL ❑ <br /> O <br /> �y Q oVT•OFSERYIC[WELL ❑OEOPFIYSJ AL WELL F 8OR SOMHO <br /> LJ O[STRlICT10H� <br /> IxiFxv[p u[f TYPC DFwRl coxa T.MUON SFSCIFiCA TVNf T� A <br /> ❑NiOVlFAIAL ❑OFtTI BOTTOM II <br /> [LA.OF WELL EXCAVATION- DIA,OF COAIOOCTOR CASINR�.T'R a <br /> ❑DOMEBTICMCVATE ❑"RAVEL PACRI517E TYPE OF CAlNglSTEELlPVC MA.OF WAU CAWN9 LI a <br /> 11 MUC MUNICIPAL ❑On VEH DEpIH of o.Lq le-k F SPECIFICATION <br /> El IRMOATG WAO ❑OTHER GROUT SEAL IHGTALLED IT v -ROUT BRAND NAME �I F <br /> ❑MO."Oft a f 411OHT SEAL pu-MD:0 Yw ❑N. CONCRETE PEOFSTAL IW OAILLPA:❑Y.. 9N. 3 <br /> AFVMX OPEN Z?cLOCK CHESTER BOXTSTOVE PIPE p <br /> �L <br /> PROPOSED coNETn+xnmEAwLUNaIwFENVEx rauDRDTARr ARLROTuer ■ueaR� . cAeLE o-rHEn <br /> I HEREBY CERnFY THAT I HAVE PRUARF.a THIN APPMATION AHO THAT THE VMlK WILL BE OOH(IN ACCOFWANCE WIN MAH"ApU1N COUNTYDI <br /> ORNANCE!,STATE LAWN,AMD RALE!AND <br /> UnIA <br /> MOVOH!OF THE SAH JOAON COUNTY.HOME OWNER OR LFCFNS[D AOEM'f W"TVRE CERTIFIE l THE FOLLOWRIO:'1 CERTIFY THAT IN THE PERFORMANCE OF TME V-V K ADR MUCH <br /> FFIIB f'EAFArt I]IPTLFD,I MALLHOT EMPLOY F'E71BON!lUBIECT TO WOIIIWAN'f COMPEN&ATIvry LAWS DF CALrO A;CONTMCT0ITl IIVDNO OR&U!{ONTIIACTPEO lgHATURE[ERTIFEB <br /> 1HE FOLLOYANOI 'I C219TWV THAT W 741 3'E1FORMANCE OF THE VMPK FOR MOCH n"PEAAITT If isf o,I&HALL EMRLDT PERSON!W"CT TO wpRTWR,T!COMPOS SAM UAW$OF <br /> CAUFORHIA,/•f/j/�E AF'PYCANT MVfi CAJ1,DL u1T!Try ADVANCE FOR ALL SLOWEDINPTFCH0 O�PR AT um 4µ!!4 am-CO MPLUE OAAW AT LOOVAR AMA PPOV10E0 <br /> fir 0 <br /> SLpr,rf X 1-1(.✓ UI.� '^'. �l .�._Tm YD. <br /> _ �L J .3 <br /> V r D... <br /> FLOT PRAHI —,.B..I.I lk— <br /> 1.NAME!OF STIIE.ETB OR ROAaf NEAREST TO OR BOUNDING THE PMPEFITY, 4,LOCATION OF HOUSE SEWAGE DISPOSAL ovulEM OR PROPO&En <br /> E.OUTLINE DF THE PROPERTY.OMING DIMINMNM Aw NORTH OIFIECTIOK EXPANSION OF SEWAGE DTSPO M MMFUR. <br /> 7.DIIALHMIONED OVTLIHEE AHD LOCATION OF ALL EAIBTIM AMD pRDpp$FD f.LOCATION OF WEELf VATHW FU.art1f Of 014E N MoIwo FIFTY FT. <br /> STRIlCT11REE,IMCtUOM COVERED AREAS BUCN AS PATIO f,DRIVEWAYS.AND WA V. ON THE FMPERTy OR AD.IuvnNO PTI nwN. <br /> l�AT1b+l FORjs <br /> CIL <br /> f�C4V <br /> l <br /> J <br /> ct <br /> l�rn� f C <br /> D EPAATIA ENT uf[aNLr II)1,. <br /> AApy.y.,I A«.M.S 4y D.t. 1 U� A,.. IIM1T1(ro,lp- <br /> OrM Fw..INn 6T a.IS RM.IrwF.etbn eT O.I. /*��N"�� <br /> I - - <br /> o...�d.I.NwpwBSn er` - <br /> �7 <br /> AccoullnlFq ONLY: RIO+ FACE �y"� Q' <br /> "CODES FEEINFO MOM RM-T CHIC—MABN RFCDvia BY D 11 FONNT1lonTCE ALVUfAr xu.IAOI IInOICT <br /> i o [1� �� iK 1 brs t6 nri�� � <br /> ? n�. �v�T�cr�z �c- intilSdri' J_t'LCJ <br /> f T' - <br />
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