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SAN JOAQUIN COU14TY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />300 EVVEBER AVE, 7b' MOOR <br />9TCCKMN. DA 95207 <br />APPUIZATION POR UNDERGROUND TANK RETROFIT, OR PIPING REPAIR PERMIT <br />TT0 PeESjrrwmiRESWOAYr FRou TmEAPPROVAL DATE. OO NOT VMITE IN AN'f SNAGED AREAS, MICATE PERMIT TYPE SEUDW <br />TANTRE•TROFIT _AIPING REPAIRIRETROFIT_UNOER VISPEWSER CONTAINNEW POAIRMTRoFIT-,_--. <br />t•...—_.....—_t__..._...----------- . <br />mSPSE <br />----BC- ----- A ------- it <br />I .1 TACILTTT ruwe Uw��•-`----- �K---- ----------------- .---- - -•- <br />1 C I -- ----- Peso???f 5�__..A F�-----------------.., ---- <br />- - -I <br />I f •-------- ' <br />I 7TRTaa ' <br />I.f •--.---.___ ..-----_._._.. 9 3k 4 -3icN <br />T I UIRYBR/aPWTOd ftc' y <br />T1---------------------------------...--•-•---------a-------___.._..... A...; <br />1_ __ 1 Plgam tl QIaD-,$�_;��iO3� <br />ICIeoRTRACTeN i1At6._____________...__._.____._.--.-,.—..—..._..j <br />Io .-_._.�_____________—___—... CA Lie Y Cy6B I <br />I ■; ---1W ;;;us sv's L41"5 Ypf�GiJ(�1+�5fE10O!..............-_.---------.-._...{��N r ----I <br />I T r_.__ __ __._ ia! e-eeiv.T9 <br />IAM <br />IC C"W INfOPNAT]OS._...........................r—___.-......_.__—_— <br />I T t______.... 11mkM <br />Ii a....._.--........_._.--�........._..-v ...............—•_ 7 <br />II ----Pao" ---------- ---- ---- <br />--I; <br />. <br />_.-.,—.-.--__--_____- — __-:__..—_____ -. <br />�— I I I I i l l l i l l l l 11 I i 1111 11 I I 1 n I I I ----'^"TAM !I� �• •� Y'1pilW CURAmR�L MV ICUM 1—a ,i�.� 7A'MI•Lm I <br />1 /L J <br />! I <br />T 17► <br />;iI7M I <br />' L I if• I I . I <br />i I oP <br />i tlb' „•i•N'Illy x' IM .� Wx'rxlewln['rieP Ilitiitl 1,,a '�I titlli:Iliitll i1111111111�1111 I"�11 r1 <br />L][\ <br />it—i{I:n iii. ..T{Ttt•1�1 �•1}TI '• .�r <br />i ! i 1 � PI OIlAlTIIOU� I <br />I L ACBiiLM VM Cob07TTMBf <br />A <br />1 „ 1•[1 1 ,.Ilnnl ,InI111I 1 FT,IUn II.AN"nw� <br />•i <br />MAKE <br />APPLICANT Nobe` NNW Wi Aim MX Tc AO®mAlin WDE BAR OOAQUIN CCUdii'Y MUZX RCLB. BTATS L W- "0 AIfLBB AM RSRR.LTtOBB OP i <br />BAN aP1RrylN CM1177. SJIY'I MERINL HOAAfM LbPARWEI 01168R OR GanSctB� AGTNf'S B10RATURR CL1.1'IPf78 TO PULLOAIMi: "f CWnFT 1 <br />S7CCIdBWBUBISC�TC YDRICSR'B CAG ROxNs mA LAu9 oS tcALiwRR IN.--VEMIT 19 1CCMEAOTOA� N[Nare ak BMPLosO Vr cr 1 9701N%NBB >•taa Tog 1 <br />TCLy0616Bi "! C151t'f17t YHAT [B tai RPCAN 6 OP TRS Rowe rtw Nn cGn ince eeuniT [n tn-�'Sl+, ! SHALL tumLex P14Mp4%R ei[AbdGT YO <br />NOA%7R'f CORP}7t74'I'ION LA.9 <br />OF Clw 3A" <br />`,�,p I <br />APPLICACT'B BtOAA'ITAEe akTLB PB63G�" P'ip�a'O(x91iCAre ( O i <br />BILLING INFORMATION: <br />Indicate the responsible party to be billed for additional EHQ staff time expended beyond permit payment <br />coverage per tank. If the party designated below is different than the permit applicant, e.g. property <br />owner, the party, must acknowlra4ge this responsibility for the billing by signature and date below. <br />IT] <br />EH230038 <br />(revised 1131102) <br />tri2'd 9S8aFLL9Y6T.6;01 <br />60 3ht/d 15 isod -6 S16V <br />#'u I • S7Z• SI ID <br />1WMU sT=T2 -es--Inn <br />5956-SLL-5I7 TS46I 900Z/0Z/L0 <br />90/Z0 39Vd IiN314NObIAN3 A37d1HS 4IIL90606 WTI 9002/TZ/L0 <br />