Laserfiche WebLink
2/02/2002 15:17 2094623433 FIFTH FLOOR PAGE 04 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 e WEBER AVe,S'�FLOOR <br /> STOCKTON,CA 90202 <br /> APPLICATION FOR UNOGRGROUND TANK RETROPIT,OR PIPING REPAIR PERNAT <br /> THIS PERMIT EXPIRES 90 DAYS FROM ThIB APPROVAL OATS, DO NOT WRITE IN ANY SHAOBD AREAS.INDICATE PERMT TYPE BELOW: <br /> ,TANK RETROFIT _PIPIND REPARJABTROPIT _UNDER DISPENSER CONTAINMENT REPAIRIRETROFIT <br /> I FFA FIT' FCAL930644582 1 raw=Q=AM P TVITR M w L'Tt�1 A: T�1'i'i�...... .......... <br /> •---•-•--------•----•--•---------• ----_.-•------------••------2II9 3-5.1_18.0,8-----•••••----.... <br /> IFI YAacxn"AKS Jack Ot Food ....__I <br /> ------­-...............P..-------ood•_Mart ............._....... RwNF 11209-239-1 Z92 <br /> 1 D 1 A 11 - - - •------••••1 <br /> i ----------•-1434 W. Yosemi e,-_ Manteca,--CA• 95336 I <br /> L I CROAS ATASR: ..................................................I <br /> IY I C4w=ICPSM]GA ARDNR N ___________________I <br /> Time Oil C_ n I I <br /> L------ --------- ------ °mP.a •-------.....------............... 80R__4z.6 -Q235-_...._._ I <br /> c l coxtnAcroR,JAlR Oil E u i • _ _ I Pxem w ': <br /> q pment• Service ......• 2Q�--.7.54-18.0.8..----i <br /> 11 1 `---..... P.0. Box 9 5 0 i CA LIC F 101mRN . <br /> 1 r------ .............. .............................. - .... .... C-�-QI <br /> IA I IKADn¢A ............................... . <br /> A1----,•-----tate._CompIn.S_...F'_Hlld,._____-... I N=QNp.N <br /> OMATNMWA� __________________________ _____2-Fi5 R52....__...____I <br /> I C I ..... ........... <br /> I .-............................ I <br /> 1 K.•....................................... <br /> ....................... w <br /> ••••IIIIII!Itl!Illllillllll!I!III! <br /> ...................................._________________ PROAK <br /> N <br /> TAK :D c _____ <br /> UPVw <br /> Y YF 0 lux i me¢II <br /> iA1 TA-� <br /> I j <br /> IKI ;w, I <br /> I I IA- ' •---I �� t <br /> _. <br /> --,IIIIIIIIIII111;1111111111111111111111111111111111111111111!Ilf IIIIIIIIIIIIIIIIIi II IIIIIIIII1111IIIIIIIIIiIllllllllllllilllllll <br /> YI /r <br /> ! L I APPROVBL X APPROVED IJx'[N cpnyi:I(C1(S) _DISAFPAD.Om <br /> A I // 14-JBU AT,ACIP:3TT WITH mupITIONPi [Y1TIL 1I SI b3 <br /> , N I AIhN RSVIIDJ¢Fw YGHS�+Q <br /> •---I 111111 IIIII!illl',IIIII'1IIIIlilt <br /> 1!:Ji!11111!IIIIIIIIIIIIIIIIIIIIIIIIII'III;III!ililllilll:!IIIIIIII1l llllllllllallllllillllil <br /> I APFLIC%T2 NR OF <br /> 1T¢MOST Pr"F3NV:AOmNX ALL Ron IN Aoo m "NITR CAN JO)CUM cpWrr ORMNANc"' wTATD.MIs. 414o XMW AND IOj <br /> PAN.o`l IN To"NFl, MAL O:ALTF'DAPAR - OMR OR LIMmm AODMIS AIauk,, L'CERTIFLNi TNR IO : I'R <br /> reRFOFmcE OF N=FOR Nam THIS PC IT IS IGIMM. Y PIP.LL NOT 00MY AIR PBRSON IN PDO,A 9WR.4R M LLORING:AL6DLRrIO CSAT2FY THAT lA To <br /> RIGONS SODI®TT rO NONnR'S CONPSNPATICN LLNP OF CALIFORNIA." QNAIJACTTA'S K-R=OA 9C9CONINAr-x <br /> FOLIOKINN: °I CM;FT THAT IN TMP C11 o1 T56 NNYCH TNPP P60DT I6 24'(JRo, � SIDOOI'RORN =TLFIN6 Tw ' <br /> CQNFZN ArION IANP or MIFORNIA." 2 NHALL IMPV]Y vsNTANS 3USJ¢c't0 I I NORFY•1'S <br /> I `/ / I <br /> I I <br /> I <br /> APPLYPANI'9 BIONAr=' TITLE Agent DAIS 1 2 20 0 <br /> Kefith A. Tallia <br /> ........................•....•..... <br /> ................................................. <br /> BILLING INFORMATION: <br /> Indicate the responsible party 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 permit appiloant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Oil Equipment P.O. Box 950 <br /> NameSyiP7G --M-A324()---Phone#?09-754-1808 <br /> 1 <br />