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I JAN. 31. 20062 9: 33AK48 GCLINEB N0. 466 P. 3 p. 2 <br /> ENVI <br /> HEALTH <br /> • PAGE 01 <br /> SAN JOAQUIN COUNTY en 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> rD!!WEOq AYE.�ROOR <br /> aTDdrraM,a rola: <br /> A►RIgA110N rOR ll061 WOUND TANK RfrROnT,OR POIMO R6PAPt PlRMT <br /> .•fltlir'EAIW�El�I OLUODDAYSnt011THEAPPROMLDATE 0ONOTWR/rt:WAM,y1 DMARtAy.�ATlrER41TTT/EY4ryw: <br /> ,••,_••„• •• sIC?ANK RETROr,1T_ IN NO RIPAIR/Rrmonr.--_UNOtROISMSERCONTNNMEMYROM;VRlTAOFIr <br /> ...................•................._........I.._........_..........-_... <br /> 1 I m rtTa / <br /> ._..._.__........ .. ..............1•n.1.OR ......OMAM a .. .Nprr • .___-...__.- ... <br /> f I rAetLiiN xl+s - <br /> t I AarAsO Z <br /> L” <br /> ._...._._,�la_ a---• ••,ter..-L. �+ - - - pp-• --?m�al/_ ...! <br /> L I awr alraT -�-.. /•- •--'-•-- -.. - -•--•,a.S-_!2/4.......... <br /> YG- pew.......................................................... I nage /I{Z-/$�� <br /> - <br /> T •••........... ....�.,�SJ..�t,Fr-•� .......� 0•LIL.'.r _ - I <br /> ..__.....-'""^'^►YALTLiiCC_ 4!`j'.5..,.._ I uDkR.G ...! b—, / <br /> O olRu LRrDRR.TS00 - .......................... <br /> OR. .L7Y.l1tT1. <br /> r ...._..__.............................. I <br /> aplt ry r................. .. <br /> •••• IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII•-•••-• _ 171CR0 ! I <br /> TAkk SO 1 __._. .......... ............... <br /> It. LTORm MA1DfrLY/!)sr I0=LT DS c VAT tv,T"LTD <br /> N 1 I). _I <br /> IA I a. -• ,-�-.�� <br /> I 13:: <br /> �'�'�''r\�%r,;Ir�}'r —� <br /> II I T ITIOW( II 11 111 <br /> Itl I <br /> II ! f MO YlWI COND2111C D[MfrOOrm <br /> V" f[iW 1lrrprlt RAID G YIM IYlmiti <br /> ••-• IIIIIIIIIIl111111111 I II lDAT8 -- <br /> M►LTONlr INR 110110+1 ALL YoIE tP )6CcpADIlCr s[tY IM JDAODIII Ca1PtN OSDEPAtt" L'[Af! Iain, AISD RDLi1 A1C <br /> OAP JNAOOI) mPNrT, D&jW N'"WM Resat• D"Mr, o" Ol Li�llm ry.JtA72aN! or <br /> $VAT lr 1tt 11 to <br /> . TNa IOR IQ TIIII arms? Is IICM, t �A=VWyWV pn MIM � �T n' <br /> we rY/.•r4 to w111o1a'r ! Or Ca'M WIA.• COlrAAC4rr•s AMIAC 00 s1�ItTAACT[N0 P[ONATi!!T CrATt)Itf »a <br /> we � I CRT 1 1Rt POU MR vltC! IIRis b11IT sr IMMIM. t SUZO q►LOY fOljpN! Lti7rCr Ta <br /> YoraO•! DY.VtlrA I YL !at , <br /> I hMLiQilr'I PI^PAtgQ� rlrLL ` <br /> I <br /> .................................. . <br /> .........................•... �+WliE / 30-r�6 <br /> iBILLING INFORMATION-_ —� a-t. .._ <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit paymen <br /> coverage per tank. If the party designated below is different than the permit applicant• e.g. propert, <br /> owner, the party must acknowledge this responsiblilty,forthe billing by signature and date helow_ <br /> ame C Adams. D t�/ f �l Phone <br /> Signature <br /> EH23003@ r- <br /> (revised 1/31/02) r,C� Qrd <br /> 44 <br /> z) +0 ( 1" <br />