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RECEIVE S v- C(,�,,- T i �, <br /> MAR> 4 HEALTH .Environmental Health Department <br /> ENVI OAMEN <br /> PERMIT/SERVICES' - <br /> APPLICAMN FM UNDERGROUND,,-$TQ AGE TANK <br /> IPI <br /> RETROFIT OR PNd A�1 AERMIT <br /> T 1a PERMn'E IRERiee IgA%FRW T ALDATE JWPJ T6PEWrTTYMsFLOW <br /> ❑TANKREIROFiT a,PIPINfiRERXMR"WM UDC R6P1tIRNIR[ROFPT ❑COLO STJAI4TJTcYR UP,6RADE <br /> F EPA Sao# 0ALOo03g7025 Pvojaacwlbw BTelep III Tom Saban 8$0.504-7244 <br /> C FadRy Name.Gemco Ripon Truck Plaza Phene# 209-5994'61 - <br /> Address 1022 frontage Rd,.Ripon,CA 95366 <br /> TCmss Street Brady lane <br /> y 0wnaff0PsrW- RAT.911,lnc, t045Airgort5ivd South San:Franc1gw,,CA89080 Phone# 88g56&3088 <br /> o -Contractor Name John Borel Winner Jr.. Phone# 650.3335558 <br /> T <br /> 0Dn6act0rAddrees 1045 Almon Blvd S San:Francisco.CA 94080 1 CALX# 824489 Class A/Haz - <br /> A Insurer Perferred Employers insurance CG:PO Box 85478 San Oiego 92186-- Wark-GomP# WKN 1660041 - <br /> 0 <br /> T I0CIrmhnk4an's Name Jphn Winn9rf2365291Rob NeimEx <br /> eyer 8248067 pljadon Date 8131119 9114119 <br /> o <br /> R ICClnstaller'sName John Winner5238529 ExphaSort Data lo/9/19 <br /> Tank system work area Tank Slag O wMicals Stored Cunarldy Date UST <br /> Owar weMo:«mna+ls+�a l.ear�uac�rz Nx) Instated <br /> T 87 piping system 12,000gal: 070ctane.Unleaded gasoline <br /> A 91 plpmg system 8 000gal - 91"he,Unleaded gasoline <br /> N <br /> K <br /> P ❑ WD" <br /> Approved ❑ Ad With condition ElPisbp_Pmvee <br /> L (See Att olunent WW'dontl"hors) <br /> N Plan Rovkvows Name Date <br /> MUST PE CfW ALL WORK IN ACDORM406 W11N SAN JOAOUINWWM-Q NMiWarATEI VMANDMX15§ANPREGULATION$OF8*1 <br /> . 06LWY,,EW9W MHdrAL N kµ7erbEPAN]tENr.QVJJ+Ea gRumtal7z, TjIAE OERrIF1E8 T{Ca yNLf1VGMlk J CERTIFY TNAT/N <br /> AhNT1G1=OF3NEWOwr FOR WHI4rHdHl$, 1G 18a11ED.1$kYfL4NOF BAP0l 1MR-ONINBWHAM11Rr�R Ti1HECIiM�$t1&IECt TO <br /> RTI�Ni HEa FFAK01iYA,r NE OFF nis DWS W SR YWA 1901ERINT'A9.1�48 E 90 SAV NPQi8dN9at1e�JECTTO V 0kT as OwWE 81TIdCl UIY <br /> OF CALIiORNIA• <br /> s �• Tyy Contractor 2128119 <br /> BILLING INFORMATION: - <br /> Indlmtetheresponsiblepedyto be Wad for addNlunal EHD staRllme experldedpayond permitpeymetd coveneW per . <br /> tank. K the peRy:dealgnetsd below b dgfe[eM'Nah ate per aPp ori a.g: Properly OWW, the pef* MUM <br /> adm*iedgetfilamaWo bil"thiblilinpbyslgpakimwd,dete,hebw. <br /> NAME -T^ Sahari - .nTUF owVF4 PHDw# 85058&3088. <br /> ADDRESS 1045Airport Blvd.South Sa/,mI'mmisoo,CA94080 1 54�4r �10� C-ol't <br /> SIGNATURE '/If" _ DATE 3 I I(I <br /> 206 . . <br />