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Ded26 13 11:24a JP Petroleum Service 916 72-4873 p.2 <br />ENVIRONMENTAL HEALTH DEPART :����� E <br />SAN JOAQUI COUNTY F-NV/RO <br />1868 F. Hazelton ,eve., Stockton, Califomia 95205HIz�� ; M NZAL, <br />Telephone; (209) 468-3423 l=ax- (209) x'68-3433 l A9rm5NJ. <br />i <br />APPLICA71ON FOR UNDERGROUND STORAGE TANK <br />RETROFIT OR PIPING REPAIR PERMIT <br />H1S PlwR`.IT E! PCRCS 7EC urY5 FR%;J T} F rSPc ktTJr.L i3f.Ts. 11v61i . is Fc�' S1T TYr'E @EEfl,N. <br />r TAiVK RF-I-ROFI T a DIEING REPAiR(RETROFFT Z:! UDC REPAMFZETROFrT : C{s<ri3 START VFc UPGRADE <br />F <br />EPA Site 9 la cty Tel aphon3'J-rn,• b:oc:mga 3C9 -9a_2-_24. <br />A <br />C <br />Faciliolmacne as Cas ::es` <br />K 2C998i-i3� i <br />f10'f7V Y.. <br />S r=-/S.G'—C{255—S. <br />r. o_-� lay, Szcckt.. . CA 95X6 <br />i <br />[ <br />CS` icy Street <br />--- _�_.._---- <br />Y <br />ovmerf0perator 2sees ?-%press <br />Correa CLOPtVaITtE if 1��• t,. I �Vl �7 r Lf'1� :l <br />Pt1?1a iv 2"--992 <br />l�i,CF,C �f �. �..w•-3'w �f ;� <br />C Mractor Address • ' GL �� ,� 4 . _ it?� i CA l.ic <br />`: i i U i ' Class 1� Paz, i. `: l.' j <br />A <br />11 r^! <br />Insurer <br />F'4�G k C orn F' �i' <br />i <br />F I 1 '1f�'',�`;.r•Y <br />i <br />!CC Tt�Tnician'sName � ���i�c l`j�il•Lll It i�� <br />�>.Firafior�[7ate J <br />R <br />- _� <br />ECC Installer's it+`Fm ''j .�ir7� �'111i fill =iEl <br />= Expiration Date <br />' ! Date UST <br />Tail: system :wont area i Tank 5i: e Che nioa'.s Storea Currerl-.iy <br />I <br />t 1 <br />K <br />o <br />;!approved ��Gpprmed vq-h cone`-bais <br />Cisapprovea <br />P <br />L <br />(See Attacftmsn_ V': lh Conditions) <br />R <br />Plan Reviewers RleVi'rS iS,NFGl L� rr l 1 lei <br />FNNFy <br />'UCANT MUST PERFORM ALL WORK IN A CORD.kN-:5 Vel P. -Q U- Ja•.QLl N CQUNI : nL.--! XGEs. STATE H.� GULr T v 5 <br />koijw COUNT'. ENU1RONh MP T AL HEl LT.'i :`DART&.'E' I GtVNER OR LICENSE) AGENT'S VZ'4ATU;1-- cP FIE; THt ."-Oi:..°3WNG'- r C R--' <br />IeY TN T i:i ' <br />PEF�FOF?F+WhlGEOFi}iE%4fuF�K�Gi�tPHSGi'rY.ESFERfiT.S±aSUaV ISHr•1LrGsEMPLOY A:dYFER--SS:NY[PSJ^H.4t;Ai.:_c'P:ST^JiFCbNkSLFSSlEC 70I <br />tR95R'S COMPE-NSA.TiON LRIWS OF CALIFORNIF,.' vONTRACTCWS mRiNG OK SU£CON RAC'I IG WC-N;nTiJSE CERTIFIEC, 'HE POLLO.w;NG: -I C€R'l WY r <br />4 i IN THE PERFORMANCE OF T.^tc WORK FOR 1.%1HiC i THIS P4'RIMT 15 ISSI;ED. I SNIFI.QY?�RSONI* tS`,BJEGT iO+il"EWS CONIPERSAMON LA%V3 s <br />caLrxo�c.r�- 1 _ 1 <br />f J � <br />vr sarety SeS r-;arucerzer._ <br />51kanJ,Tc T;. <br />ts51aaa1cre r' 'J!.-,.�� _ _1 «��' ::u ���.. --...- _ .— - - <br />MILLING INFohMP i ION: <br />lnd4Cate the resins;ble part' to be tlllled ltr addiucr¢a1 l -ME) 5:311 filmy a?,p '1Gt;6 beyond para _ pcy:Trl:;Ili c: Yerbec pc -r tank. :i <br />the party designated below is diiferent :hen pe;mil applicant. e.@. prop=rh• ori^ -r, the parlt n=ust acitroylledge this <br />responsibility f for the bilfiN by sitgneturwff and date 4alow- <br />9�d [(k TI LE <br />ADDRESS <br />EM2300?6 (revised '10.'3(!12) <br />