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r <br />roto OCnIICCT <br />Type of Business or Property <br />FACILITY ID # <br />SERVICE REQUEST # <br />COMMERCIAL <br />X79 00 <br />' 01 G PAxrY <br />OWNERI OPERATOR JARGENDER SINGH <br />FAcnmNAME CAPITOL AUTO SALES <br />SGEADDRESS <br />E MINER, <br />AXEP, <br />650 srw Numb. <br />o4emon <br />sb x m� <br />Mailing Address (If Different from Site Address), <br />SAME AS SITE ADDRESS; <br />STATE ZIP . <br />CITY <br />W. '�APN# <br />LAND USE APPLICATION <br />PHONE #i <br />(20 466 9082 <br />a <br />80S DISTRICT ; LouTaN CODE <br />• <br />PHONE #2 <br />• GVHIt(At.IVttr <br />BIWNG PARTY Cl <br />REOUESTOR <br />BUSINESS NAMEJAMES J. HOBLITZELL F 0 9# 9 4 3 7 7 9 3 <br />MAILING ADOR.ESS B O X 30331 1 2 0 943 2 8 1 1 <br />CITY STOCKTON <br />STATE nA LPn52i�—n�3T <br />BILLING ACKNOWLEDGEMENT: I, the undml ned property" business, owner, operator or authorized agent of same. admowledge that all site andiOr project specific <br />PUBLIC HEALTH SERVICES EtMRONMEHTAL HEALTH OIvLSIaH howdy urges associated with Nis project or activity will be Wed to me or my business as iderrofied on this lomL <br />I also cerdfy that I have prepared this application and that the w Irk to be performed will be done in accordance wit all SAN JOAaW COUNTY Omnance Codes, Standards, STATE and <br />FEDERAL laws. <br />IDA._ 02 APRIL 2 0 0 1 <br />APPLICANT SIGNATURE: <br />OPERATOR/NIGER ❑ OTHER AUTHORIZED AGENT ❑ 074>-7wt <br />PROPERTYI BUSWESS OVIN Title <br />p.�uxY�cwfisndtheB v. p=fclaufharmdarfualgnisregered <br />AUTHORIZATION TO RELEASE INFORMATION: When a )pkable, L the ovmer or operator of the property bated at Ne above site address. hereby authar¢a the release of <br />any and all iesub, geotechD'xml data andlor emironmentallslbl assessment infatuation Io Ne SAN JOA(UW Calm PUBLIC HEALTH SSWICES ENVWONMEt(TAL HEALTH OIVuwN as soon <br />as it is available and at the same time it Is provided to = or m/'P.presenmtivve. <br />TYPE OF SERVICEREQUESrm: CLOSURE OF O�IE TANK (UST) <br />COMMENTS: <br />RECEIVED <br />APR 10 2001 <br />SANJOAQUIN COUNTY <br />PUBLICO HEALTH SERVICES <br />ENVIRONMENTAL HFALTH DIVISION <br />"APPROVED BY: fV4C EYPL^Y� <br />ASSIGNED TO:EMPLOYEE#. DATE: <br />Date Service Completed ( completed): SERNCECoDE .. '.'.3 P I E2 j0 <br />amount Paid Payment DateFee Amount: 0-1� <br />Payment Type Invoice ' Check#ir10 ?931825)5 eceivedBy: <br />wri6,a D(es3(08 <br />X79 00 <br />RECEIVED <br />APR 10 2001 <br />SANJOAQUIN COUNTY <br />PUBLICO HEALTH SERVICES <br />ENVIRONMENTAL HFALTH DIVISION <br />"APPROVED BY: fV4C EYPL^Y� <br />ASSIGNED TO:EMPLOYEE#. DATE: <br />Date Service Completed ( completed): SERNCECoDE .. '.'.3 P I E2 j0 <br />amount Paid Payment DateFee Amount: 0-1� <br />Payment Type Invoice ' Check#ir10 ?931825)5 eceivedBy: <br />wri6,a D(es3(08 <br />