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02/24/2005 14:37 19254672472 SPttwAr <br /> PAGE 02 <br /> SAFEWPV <br /> 02/14/2006 - 17:05 192546�y/2 `� <br /> Ar.•oew-I .ALuvCk LUIVSIkUCTiCPI N�.J.31 P.2/9 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 154.5 WEEER AVC.3"FLOOR <br /> RTCCKTON,CA 1169112 <br /> APPUaATIaN FOR UNaERORDUNa TANK RETROFIT,OR PIPING REPAIR PERMIT <br /> THIS PIRIMEXPIRED 20 DAYS PROMTMOAPPROVAI.OATS, OO NOTWRITG IN ANY RNAOMMAR6AS INDICATE PERMITTYPE RELOVJ <br /> _TANK prMofrr_PIPIgO REPAIRIRETROFIT UNDER DISPENSER CONTMNM"T REPAIRMFMOFT____----------- y <br /> _._-.__—________ <br /> W I I RPA Irm 4 P2mRT Carckm' R M17![.RPImWR P _ <br /> �aQ3_ -- -pRo® id� je <br /> r eRCTL2RY MA7a _—---—_ <br /> 5 <br /> I � > zSmuuA ------------i <br /> 1 c GIe66 R'Rf7! ___---_____--_ _______ <br /> __ <br /> . e I CWRSR/SPSRpneR 4B�i° R <br /> f ° t----------- -----rtC�aa�r 61ts�ES i�±Jr•,.�---------------+-------'�s��jy�rl. 5�.��_..� <br /> C CAm��N6 M •I 4LARR —---------Irl CV.7IDAOTD1l Aa51mRR I o LTR p <br /> 1 A I IRWITRRA j--__— _______-_--__---_—_.. <br /> ______._.___—_....___.—_________-__ _—_. <br /> A <br /> j organ nommRl67 I <br /> -- <br /> ai <br /> I PI7llA P f <br /> Van, 15:21P ....cm_ S. PM Cf91R]7nTLS/PSERxDORLY 77ASit a IW6cALLlm _ <br /> i 77 1NPR io R _� [Al� —1A�.R IM E '"Uh7L I <br /> it, C _ <br /> 1 A I DD• �— MIl-i riM _� /a w�4 '+�—i��- �—_, <br /> I W <br /> W ! <br /> _ I I <br /> !'p i lnl:::l:a ,1 :III II11111Iiii;;I::::::::;::411 11:iii ii 11111 IIII III II!:I:77777 I::: III- If II�I a II r <br /> Im A'rmanew WITH CCW IMMnl e �$i P+RW 7=11IWSRR fO�vW <br /> f--I I; IIIII:I::I1;;!7:::111 IIII LIIII 1.1111::;1:;1111!'n III I. 1111111: !1: III i i: � :111 7777 IIII IIII I'.I ::: <br /> I A a Mi kqo 1 00 P)01l5WW ALL"Imcoro IW AT"was M d WS®7 RAN w. DAW °ems DARTWAW®AL—R77�74W 7a.W61 AWO WIW®R AWa p]SWLATIOPR CP <br /> RAR IOA4tR21P ODORRS. FAIPRICU 71�R9 67s61IIM1A®•2- O761AA, OA LICROARa A511W2'A lSmrow " PO ACR'115! eSL A,UAW7 °7: CDs7RIP[ <br /> j RMT :W eWW L7DtPCA64�WC0 OW 176 an PM 111302 T= PITIMIx It 2R1D0a. I SMLL IDT A71PLD1'AMT PARAOW R R[M1Vl A IIA17RpP. Rn x5 I <br /> I 1200WR ROLTCT 19 ■=00'11 C9WWNRATICWR tW:' OiW.iP9nSn.• OOWRU�PR'R WTSWO M PSRCCW4We MU* RSR7Ai`PR` CWATIWIPR "T' 1 <br /> 1 A5AL5W2WRI •1 1291112911="WxipT 2W 31101PIRITa"IS IM OP TIM Wool PCR NAIM 'Tolls P 17 T1 WWII OML 7*=CT PARGONR szmn ar T5 <br /> WORIae4'W OONPRKOAS25R SAWS o8 murc o4h.• <br /> I I <br /> rAPPL2em"IC RSOWYTRAa. xI'Dv7 ane° 11 <br /> �•-•---------------"----------"-------^---------------------------___- -------+ <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for addltienel EHD staff time expanded beyond permit payment <br /> coverage per tank' If the party designated below is dffferont than the perm(t applicant, e.g. proparty <br /> ownar, the party must acknowledge this responsibility for the billing by algnature and date below. <br /> Name,sit~ '&&t, Address �„ Oil t-Ls 1.2Le Phone# 2 . 35�� <br /> � �- 1.gelnl,c , 44�. SSo38 '`ZU4(D. <br /> Slgnature _i <br /> EH230038, <br /> (revised 1131102) <br /> i <br />