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$MVtCE REOUESC <br />Type at Business or Property <br />FACILITY ID <br />SERVICE RECUWr S <br />2'7-i,NKs <br />BUSINESS NAME <br />15(200-361:2 <br />PAYMENT <br />CWNER I CPSATCa <br />DIESEL PERFORMANCE, INC. <br />& NG <br />PARTY Q <br />FAMITY NAME DIESEL PERFORMANCE, INC. <br />IF 0 368-1851 <br />CTY Lodi <br />SITE AccRESs 2900E.m. <br />Fremont - <br />- <br />I St. <br />I <br />SAN JOAQUIN COUNTY <br />she,. er <br />os <br />ses.i <br />*A. <br />m.a <br />Nailing Address (It 0111 tlm8d <br />B�3 <br />HEALTH DEPARTMENT <br />W3PEC'CR'S SIGNATURE: <br />CCNrzsC'cR's SiGw+.tuRE <br />87 <br />APPRCVEo Ery: fJ ( t v c l t2y{ <br />jEspt--Yza 1. p 3 Z r <br />CAT`—' <br />cay Stockton <br />AszmNEC TC: C' �j <br />CA 95208-0387 <br />OATS <br />t ear <br />APN� <br />SEavtc CcCE: <br />WeUsEAPPL=TmN. <br />I <br />Fx Amount 7 ct 00 Z= Sbount Paid <br />(201 <br />(20� 946-0233 <br />I Payment Date r C Z D /2 <br />Payment Type ,� <br />hlvoiea 9 <br />PxortE 2 er <br />BQSDtsrts _ <br />LocameCow. :... <br />-CCNfRAGICR/ <br />REMESMRRu <br />1 me PARTY Q <br />JIM THORPE'OIL, INC. <br />2'7-i,NKs <br />BUSINESS NAME <br />PtmxE 3 am <br />) 368-6175 <br />PAYMENT <br />P. 0. Box 357 <br />RECEIVED <br />IF 0 368-1851 <br />CTY Lodi <br />STATE CA Zip 95241-0357 <br />BILLING ACXNCWLtQGe?AE?fT: l 0e unammggned pmperty or business owner, operator or auNaraed agent of soma adm wledge that ail sk ard[c projeC spercic <br />PUEI..'C HEu-�+SERVP S EWFCNt@rtK HEN.1N C houny emiges assn ated wM Sa pajeC or a=vity nil be Sled b me army business as dsmtied an chm `ami. <br />1 arse wily tat: have P ti' appfi®irn to wane b he Perla Nd be Acne n ac=r=m mi h ad S. rCA=N (—uNTY Cralls= Codes. Standards. STATE and <br />FSERAL!aws. <br />APPt;cwS%ww-ru A Fred Miner OAr� <br />Presiden <br />PRCPE7TY/9USNESS CWNER �'� CPE.4AiCR1 A4ANNGc'i Q Ct}ER AUMCa® Gc/T C <br />Y.tco_evn' YiA[_rePum. pmdo/aadraraWon msgr$ngared rifts <br />AUTHOR CN TO RELEASE INF NATTCN•'Nhen anp6aole. L die awner or apa= of to pro peny'aated at lie above sit* address. hereby aurherta tie ukase at <br />any and ad resurts. gecteene:al dam arn]far emmcnm onmYs a assesanem hrtonnadon b tie SAN:GICTIN C U4rr P'iaLC HEAL.H SEAS E:IVNCWE?AL HFx7,a CN=4 as $oar <br />as 13 available and at the arcs 3M :t a provided b me of my represmmuve <br />TYPE OF SERVICE RECUE=: Underground Fuel <br />Storage Tank Removal <br />Permit <br />2'7-i,NKs <br />CCYNE'(i5: <br />PAYMENT <br />RECEIVED <br />Nov 2 0 2003 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />W3PEC'CR'S SIGNATURE: <br />CCNrzsC'cR's SiGw+.tuRE <br />APPRCVEo Ery: fJ ( t v c l t2y{ <br />jEspt--Yza 1. p 3 Z r <br />CAT`—' <br />AszmNEC TC: C' �j <br />EmLLCYEE S (f,3-7,3 <br />OATS <br />I f Z QZ <br />Data Service Completed (If already camploW: <br />SEavtc CcCE: <br />O3 P I'e ,z 3.0 <br />I <br />Fx Amount 7 ct 00 Z= Sbount Paid <br />I Payment Date r C Z D /2 <br />Payment Type ,� <br />hlvoiea 9 <br />Cbecx <br />Received Sr- <br />