Laserfiche WebLink
12/02/2002 15:17 2094583433 FIFTH FLOOR PAGE 04 <br /> J <br /> 0 • <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 301E WEBER AVE.3'PLCOR <br /> STOCKTON.DA 90202 <br /> APPLICATION FOR UNOERCROUND TANK RETROTIT,OR PIPING REPAIR PERMIT <br /> TNIS PERMIT EXPIRES 90 DAYS PRO HI APPROVAL bATE, 00 NOT WRITE IN ANY SHAOEG AREAS.INDICATE PERMIT TYPE BELOW. <br /> -TANK RR 1 ROFl I A_PIPINC REPAIRJAETROFIT __UNDER DISPENSER CONTAINMENT REPAIR/RETROFIT <br /> 4FA SITS N R '[�//y��y(y.' - - 'K2it?r-A;...Ta22Y•a-...------••-•� <br /> i TMdRWNB N , <br /> .. PGa1�F Wln71C1' aaa -�sa. a gn$------------ - <br /> IE -----PACI'--- NAY-- ••--•-- <br /> I A .-________.------- <br /> Jackpot Food MartI RF`Pe •209-727-5442 1 <br /> -- - - - ---- - ------------------- - <br /> • .........................................I <br /> 1 ......P 14000 E. Highway 88, Lockeford CA <br /> ......................................... <br /> I L I CW99 93AGY <br /> 1 2 -----•--------•------- ,y............... 1 <br /> I T I aaml;c9EA\TGR - - . - - - • - -I <br /> I Y IRand Ha wood iNPNG w 1 <br /> -------------------X.------x•----..,---•--------........ 1 209-727-------------------------- <br /> . <br /> _5442__ _ <br /> __ __ <br /> c......... .... Oil Equipment Service 1 PRAOi. <br /> I <br /> 0'!............................. 209-754-1808 I <br /> P ' ---GR Am---i .....• Box 950 1 xA Lsc u <br /> ---------------------------------------- <br /> ------ I <br /> I T ----------------------•----------•-------• 32341 7 I GLAGG A-Haz C-1K) <br /> I , 1 INscD� - --------------------- <br /> ----------- i <br /> AiState Comp_ Ins. Fund I 'IRK'00HP1265057 <br /> -------------••--------••• -- <br /> . __..r-i C I 011312R TUFMAT:0 •.......................... <br /> ...__._._.._I <br /> r .-----...-•----------------- <br /> A.............................................. I <br /> ..... n <br /> SPINS . <br /> -- <br /> ••••lllllillllllllllllllllllllllllli••----------••___...• .- <br /> ! <br /> ----------------------------------------------------- ................I <br /> 1 39- IANG_O P TANK SI28 1 C rCAIE STOAm C''xA.iMLY/PFRIKGViLY I DAIS UST INSTALLm I <br /> A 39'— I 1UTrkn wT—I <br /> B 39 I�'�Q-Q'Q' I -GaSa2L��L1'Iii'{7TbWI1--I <br /> R I PF• I i ra <br /> 99-_ `i '7f7S7f— —I I <br /> a_ I ! aso i `;U-n "PfnyT—I <br /> --IIIIIIIIIIIIU11111111Iu1nInlllllln!u!Illnll�!'illnl!Ilullilln nllllyln�nlllnulll llrullu!uII7111 lllnul ill Ili <br /> L AFPRevnL �7AFFR7W NIT. ( `r 1 <br /> A 1 LRrDLIION A) —DISAYPRa.2e <br /> (GYP ATCACROM NIn =wRIT.-M) <br /> N I PIAN PSVIYWFRS IA116 MRTS <br /> . . ---I I!Illlllllllllllllll.lilll 1111 .III %I 'II IIIIIIIIIIIIIII'lillllllllillli;ll;!I11111 Illl,lllllllllllllllllilllil <br /> I <br /> APPLIC:NT YIUST P9RPCRK ALL NOP% IN ACCW9wa BITR IGAGOxA CWP:9'GRD/ <br /> I SAN,Io,;='N DgM71• FNVIRGt.ffI XMMI L.PARTIoall'. "MR OR 11=0m M'S S, .STIR LANs, AND POLES AND AWOfATIGNB OF I <br /> FORM'S .LGYATN A CERTIFIBfi TNc 99Lf/JNitIG: •I CeGTLTY I 'DAT m TRC <br /> TFAAZVOMNCE OF Il¢0 NO FOR S COI IMI9 PGNNIT IS ICCRRO, i GImLL NOI @9WY AIR AGR90d M .t,9t A 1WR,TR lit ro I <br /> Gi�1Tn6.GDIPCI T^NG.19R'9 CONRID(SATICN 11N9 OF CALI:VPN.A.^ CFZ7Rk- R'i G_GxNe OA 9O9COVxxAC:INC .IGI417M CA "'z IRE <br /> FGLtIJWiPx: "x CMZFY THAT IN TNA PSRFOAANOP or 2�Nptf', FOA UNION T Z$ PEPNIT Ii IGGOGA, I SNAIL PlIrLOY VCtWN9 Snag=ro i I NORM, <br /> caa MmTIm EMS or CALIFORRlA.' <br /> I I <br /> 1 I +'°PLIGAL'$'B eI°NA'rIx°' TITLe Agent �R 1 2/1 9/ 2 <br /> ith A. Tallia <br /> ------------------------------------------------------- <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment <br /> coverage per tank. If the party designated below is different than the permit applicant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Oil Equipment P.O. Box 950 <br /> Name Oil <br /> -qaIlnita A �-CA a5249_Phone#_ 02 9-75. 1 08 <br />