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PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY qr � <br />FNVIR.ONMENTAL HEALTH DMSION <br />Kartn F=r, M.D., M.PH., Health Offietr <br />304 East Weber Avenue, Third Floor • Stock -ton, CA 95202 <br />2091468-3420 <br />PFRMIT APPLICATION <br />TO INTERIOR LINE/REPAIR UNDERGROUND STORAGE TANKS <br />NOTE: ONLY UNDERGROUND STORAGE TANKS CONTAINING MOTOR VC11ME FUEL MAY BE REPAIRED BY THE <br />INTERIOR LINING PROCESS- IN ACCORDANCE WITH SECTION 25296 OF THE CALIFORNIA. HEALTH AND SAFETY CODE', SVCH AN <br />UNDERGROUND STORAGE TANK MAY ONLY BE REPAIRED ONCE. <br />Site EPA # <br />Tank ID # <br />Facility Narne:_ _GeT - 4 - an MJ144 Facility <br />Address- 574 w Csran-i• City---[-r-ao <br />State:O-A Zip Cade: ?5317b <br />Contractor Name: 1� € � l�rc�41kne- Serute.e �,c. . <br />Contractor Address (mai)5 City: <br />5 -6Qngf5 State:_LLk- Zip Code: cl3Ic35 <br />Lining Contractor:_ <br />Contractor Address= <br />State: Zip Code: <br />'It Approved <br />❑ Approved with the following conditions - <br />nate R.EM.& <br />❑ Disapproved <br />Lining <br />City: <br />A Divis a of San Joaquin County Healrh Cazc Servicm <br />LIZ 'd BZW O N 9991-M -60Z Wdl9:Z 6661 '1 'unr <br />M <br />H <br />Z <br />T <br />12 <br />M <br />H <br />J, <br />S <br />n <br />R <br />D <br />H <br />