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- ee IniteeD rrliel. znyay��ya rJ10 • PAGE 02 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> )w E VRISJCR AVC,3I4 FLOW <br /> STOCKTON.CA 062M <br /> APMIC47ION FORE UPGRCKJND TAMC RETROFIT,OR PIPING R@PMR PERMR <br /> THIS PEAW IT EKP9WS ID DAYS rROM TNG APPROVAL DATE, OO NOT MrM IN ANY OWED AREAS.WMATE p@RMT TYPE NeLOw: <br /> /• —TANK <br /> yyRE"�TRyo[fy�7i,T/—VF#N'a RSFAIPJ"rRDPIT—UNOER 0I9PE46ER CONTAIN WENT RSPAIR,RETROFIT <br /> -NPA P219 P G OQuRy I FC J_�! -_ -PPO1L'Rr•WD CT a 7cu"Wr <br /> • rAO2LT1r NAM •_ a•..................... •----. .I -_,--_ <br /> ..... "i - ­­ <br /> _% <br /> �I <br /> ----- 3 + Tis' .. f <br /> ! •••-'-••••- 1 1N!V10 I �p�_ <br /> Ana <br /> t�Q__rl__,ln...._- <br /> Caw M� E?F�a k- G4 <br /> --- � a_...._..---- <br /> PRONE A <br /> ! ; tDNTRAttPE A� - ---•-•-----�- <br /> ! CONTRACTOR ADORKW - - .D_._.___ _• .�. '_ <br /> .�./A� �/� /A � i <br /> r :'t12UR •'[-'T-�Tri/S..L('sG �P/. ./.,--J�-/................a3���_X'O - �y <br /> xf-�'XAF-ITL..................NMS—ct1fP.1__--------rte= . <br /> t DTIm lNPDtKAr1aW �� � •_ - .__ ___ - <br /> R <br /> •.. ♦;.:' I!I',:II:I II I..':I!l:::i::li <br /> _ .._ <br /> .............. l -t P <br /> -- <br /> ...._..... <br /> PmgR . <br /> SL[ <br /> W „,_I! CNCNIQALR q'TOAi6 CIIRRLNTLT/vn�J10LPL1 1•WTIl{(yI iKPYAL!,GL1 <br /> I.:Ifa ::!t.11 I :�I II• .,.I;. - ! II11fi -.77 j1111:..'�. <br /> A •_- ADPIOVm APPSDWD WITR CCFDITTGN AI Pp <br /> K PLM IITVILWCRA RANK ATTAEANOIT W178 CCNDITIMR •^`• DIRAPPWCV <br /> •• 11111III!I!I!lil:; :,i.::l I R::. 11::!1,1.I.I I; II:! 111TH <br /> •• <br /> . NLICAWi MUST ICATpRK RLL NJRR [W ACCORDANCE WT% SM SOAOOIN MLWTT DEDTWANGCL, N2ATK LMP, AYD RVLPD AND RACWIATIOAR of <br /> JOAOOIN Co(AYTT, NNPI pa RAMTR OR LT4499ID ACENT'S CIaK(14DKe L'HRT'IFINI THE W4LOMI!+O: •7 ChTT TY <br /> T IN TN[ P R) TNN WeRK WKIp d1T .I JCONTR t t”"KPT OKTLOT ANr "MON De aCCN A KARN4A As TO <br /> D PPNJ[Cr RAM-$ tDMINAATT IJW6 Or CALr2O , <br /> CWI01O1 q CIRS TWT TNI COI MNa OF TNN rpgK Po [4K'II TN 04AR2'T ft ; R AMM WACTSN ST@wxutR MRISTIts TK k, I <br /> 'R COKIIIIN TT c TTOAR ROI:D, I'rML p0my PN Oqs 209j T TO <br /> FtCM1TNR[I <br /> BILLING INFORMATION: <br /> Indicate the responslble petty 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 penult applicant, e,g, property <br /> owner, the party/must acknowledge this responsibility for[tJg billing by signature and date below. <br /> Nam 5Af t A931S Address �D� G/�'t7F �Q phone #;_�- � <br /> $ign tore�— Owe . &5::,.6 <br /> EH2 0038 <br /> (revi 1!39102) <br /> r 0In YF3 SO:CO aTOZ,LZ/ T <br />