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SAN JOAt,` COUNTY AIR POLLUTION CONTROL 6TRICT <br /> 1601 E. Hazelton Avenue, P. 0. Box 2009, Stockton, California 95201 <br /> Telephone: (209) 466-6781 <br /> Application for AUTHORITY TO CONSTRUCT and PERMIT TO OPERATE <br /> Date: 9-4-75 Application Number: 09 j`, <br /> An application is required for each operation described in part B of instructions. <br /> 1. PERMIT TO BE ISSUED TO: Business license name of Corporation, Company, Individual <br /> Owner, Partner, or Governmental Agency. <br /> TERRIBLE HERBST, INC. <br /> 2. MAILING ADDRESS: <br /> P. 0. Box 2983 , Huntridge Station, Las Vegas, NV 89104 <br /> 3. ADDRESS AT WHICH THE EQUIPMENT IS TO BE OPERATED: I CITY (y ) COUNTY ( ) <br /> 16 South Cherokee Lane, Lodi , CA <br /> 4. GENERAL NATURE OF BUSINESS: <br /> Gasoline Service Station <br /> 5. EQUIPMENT DESCRIPTION: Pursuant to the provisions of the State Health and Safety <br /> Code and the Rules and Regulations of the San Joaquin County Air Pollution Control <br /> District, application is hereby made for PERMIT TO OPERATE the following equipment: <br /> Displacement system for Vapor Recovery <br /> See attached control plan <br /> Continue on additional A x 11 page if space above is insufficient. <br /> 6. TYPE AND ESTIMATED COST OF BASIC EQUIPMENT: <br /> $3 , 000 . 00, see control plan for type <br /> 7. TYPE AND ESTIMATED COST OF AIR POLLUTION CONTROL EQUIPMENT: <br /> $5 , 000. 00 , see control plan for type <br /> 8. SIGNATURE OF APPLICANT: TITLE OF SIGNER: <br /> Chuck Brozik Operations Manager <br /> 9. TYPE OR PRINT NAME OF SIGNER: <br /> i <br /> Nom: Chuck Brozik TELEPHONE NO. : 702-382-3929 <br /> Validation (A.P.C.D.) use only <br /> Date Application Received: Fee Schedule Number: <br /> SEP 10197 ( Filing Fee:S4 <br /> cj'&O Permit Fee <br /> EH 01 20 Rev 1/74 ^ '- -- - <br />