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SAN W O U I E nvironmerital Health me nt <br /> COUNTY RECEIVED <br /> APPLICATION FOR UNDERGROUND STORAGE TANK AUG 2 12925 <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 1013 DAYS FROM TH E APPROVAL DATE �IN DICATE PERUrr TYP ()N ME�T�� ���I.�� <br /> D TANK RETROFIT D PIPING REPAIRfRETRORT ❑UDC REPAFFURETROFIT D COLD sTmb%49W"A i! <br /> F EPA Site# Project Contact&Telephone 4 Alan ThrokmOrton (714) 567-6416 <br /> A <br /> Facility Name AT&T GaIifofnia- UG010 Phone#(800) 566-9347 <br /> L Address 1812 Coley Ave. EscaIon GA., 95320 <br /> FCross Shea# 2rld Street <br /> y OWWl Operator Pacific Bell Telephone Company dba AT&T Catifornia Phone#(800)566-9 47 <br /> C CaMractur Name TAIT Environmental Services Im. Phone*(714) 567-6416 <br /> N Contractor Address701 N, Parkceriter Dr. Santa Ana GA„ 92705 CA Lic Class A-HAZ <br /> t <br /> A Insur9rAXI S Surplus Irxs>.Irance Company Work Comp# 7 034 39 5505 <br /> 7 ICC Technician's Name Christopher Bagan Expiration Date 0 1-2 8-202 5 <br /> O R ICC Irlstatler's Narne Expiration Date <br /> Tank system worts area Tank Size Chemicals Stored Currently Dace UST <br /> ji.a.e7 poMg maj%91 Peg daUK W.UDC In.Crtl installed <br /> T Fill f Piping Sump 1000 Diesel 04-01-2004 <br /> A <br /> K <br /> p _1 Approved Approved wEth condltlons ❑ DisapWved <br /> (Sea Attachment With Conditions) <br /> A (� <br /> N Plan Reviewers Narne C Date <br /> PPLICANT MUST PERFORM ALL,a~ORK 1N ACC DANCE SAN JOAQUIN COUNTY ORONANCES,STATE LAWS, AND RULES A140 REGULAMNS OF SAN <br /> OAQUIN COUNTY. ENARONMEHTA(.HEALTH MPARTMFNT.OWNIFR OR U[I EN$F-R AGENT'S SIGNATURl*Cl•RTIFRES THE f!MCWNG; 'I CERTIFV THAT IN <br /> HE PERFORMANCE OF THE WRK FOR VN1CH THIS PERMFr IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SRJ W EGT 70 <br /> RKER'S COMPENSATION LAWS OF CALIFORNIA- CONTRACTOR'S HIRING,OR SUr3CONTRACTING, SIGNATURE CERTIFIES THE FOLLOWING: -I CERTIFY <br /> AT IM THE PERFORMANCE OF THE WORK POR v1MICH THIS PER MIT IS IS$UEO.I SHALL EMPLOY PERRSON$SUBJECT TO V4RKER'3 COMPENSATION LAWS <br /> FCAUFORW.' ow+r�,,.utrFErrtft o <br /> Ernie 13rava I,#, T � Permit Processor 08-20-25 <br /> - <br /> rpm mrwa sk"ffhua <br /> BILLING INFORMATION: <br /> Indicate the rs$pon$ible party to be billed For additional EH D staff time expended beyond permit payment coverage psr <br /> tank. IF the party designated below is different than the perrrlit applicant, e.g. property owner, the party must <br /> acknowledge this responsibility for the billing by signature and date below.NAMC Ernie Bravo TITLE=Permit Processor PHONE#( ) 7-007 <br /> ADDRESS 15012 beglinde Dr. Lake Elsinore CA., 92530 <br /> Ernie Bravo Nitelly signed tyyErrlleBrave 08- 0-2025 <br /> SIGNATORE Dale;2025.0.2017;41:14-07'40' DATE <br /> 2 of 6 <br />